Stacey Wallace, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201011236 Issued in MI

Practice address

5600 Waldo Ave
Midland, MI 48642-6438

Phone

(989) 575-3255

NPI assigned

Apr 5, 2022

Last updated

Apr 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powerback Rehabilitation LLCGroup PAC ID 2365359932, 600 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Shelby Township, MI
  • NPI 1912226366

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Bay City, MI
  • NPI 1942829064

  Occupational Therapist

  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Occupational Therapist

  NPD
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1790640761

  Occupational Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1043951957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 BINSCARTH AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486023203",
            "telephone_number": "989-327-9967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 WALDO AVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486426438",
            "telephone_number": "989-575-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STACEY",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201011236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse G Walker
• Karissa Walker
• Rena Walker
• Debra L Wall, AUD
• Carol Seeburger Wallace, MA-LPC
• Lauren Mariah Rose Walls
• Zoe Walters, PHARMD
• Karen Ann Walton Ebnit, CCC-SLP
• Vivian Wang
• Kaitlyn Wangler, MA LLPC

• Occupational Therapist in Midland, MI
• Providers in Midland, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.