Basic Information
| Provider Information | |||||||||
| NPI: | 1831189869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 W GEORGIA AVE | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836866811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084633234 | ||||||||
| FaxNumber: | 2084633044 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 E FLAMINGO AVE | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836879203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884970 | ||||||||
| FaxNumber: | 2084633044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT530 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000010150362 | 01 | ID | BLUE SHIELD | OTHER | W1044 | 01 | ID | BLUE CROSS | OTHER |