Individual
STACEY HICKS NESBITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6507 QUEENS WAY DR, COLUMBIA, SC 29209-1530
(803) 360-3225
Mailing address
6507 QUEENS WAY DR, COLUMBIA, SC 29209-1530
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
SC
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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