Provider Demographics
NPI:1447316351
Name:ESCH, STACEY (OT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ESCH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 COORS BLVD. NW STE. 100
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-239-8969
Mailing Address - Fax:866-447-8129
Practice Address - Street 1:2929 COORS BLVD. NW STE. 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-239-8969
Practice Address - Fax:866-447-8129
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist