Provider Demographics
NPI:1043929268
Name:MERIWETHER, STACY LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:MERIWETHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 ABELLO RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8864
Mailing Address - Country:US
Mailing Address - Phone:321-362-2839
Mailing Address - Fax:
Practice Address - Street 1:398 ABELLO RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-8864
Practice Address - Country:US
Practice Address - Phone:321-749-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT23669225X00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center