Individual
STACY A HARMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4400 E FLAMINGO AVE, NAMPA, ID 83687-9203
(208) 288-4970
(208) 463-3044
Mailing address
217 W GEORGIA AVE, SUITE 115, NAMPA, ID 83686-6811
(208) 463-3234
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT530
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150362
BLUE SHIELD
ID
01
—
W1044
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
02/09/2010
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