Individual
STACY LYNN GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
384 MAIN ST, WOODLAND, PA 16881-7802
(814) 592-1626
Mailing address
384 MAIN ST, WOODLAND, PA 16881-7802
(814) 592-1626
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP007578
PA
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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