Individual
STACEY LATRICE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4513 JON STONE LN, ARLINGTON, TN 38002-7536
(901) 461-0621
Mailing address
4513 JON STONE LN, ARLINGTON, TN 38002-7536
(901) 461-0621
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2827
TN
Other
Enumeration date
04/26/2012
Last updated
04/26/2012
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