Individual
MRS. STACI L. GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/CHT
Contact information
Practice address
700 GENEVA PKWY N, LAKE GENEVA, WI 53147-4594
(262) 249-3500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1931
WI
225XH1200X
Hand Occupational Therapist
1931-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40739600
—
WI
Enumeration date
10/19/2005
Last updated
02/24/2025
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