Individual
MISS DAWN MARIE STACKEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTRL
Contact information
Practice address
2000 W COMMERCIAL BOULEVARD, SUITE 101, FORT LAUDERDALE, FL 33309
(954) 351-0511
(954) 351-0411
Mailing address
2000 W COMMERCIAL BOULEVARD, SUITE 101, FORT LAUDERDALE, FL 33309
(954) 351-0511
(954) 351-0411
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT12433
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG243
MEDICARE PTAN GROUP
FL
01
—
AG427Z
MEDICARE PTAN
FL
Enumeration date
11/08/2006
Last updated
02/18/2008
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