Individual
MISS STACY ELIZABETH VANWASSENHOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
137 OVERHILL DR, SUITE 102, MOORESVILLE, NC 28117-8006
(704) 799-6824
(704) 799-6825
Mailing address
1121 FIELDSTONE RD, MOORESVILLE, NC 28115-2737
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5215
NC
225XP0200X
Pediatric Occupational Therapist
5215
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301656
—
NC
Enumeration date
04/26/2006
Last updated
09/11/2025
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