Individual
STACY M CISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
755 SAINT JOHNS AVE, LIMA, OH 45804-1552
(419) 996-3400
Mailing address
755 SAINT JOHNS AVE, LIMA, OH 45804-1552
(419) 996-3400
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
003144
OH
Other
Enumeration date
02/09/2014
Last updated
02/09/2014
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