Active NPI
Stacy Allieou Wilson, OTR/L
- Occupational Therapist
- Fayetteville, NC
National Provider Identifier
1114236346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 7684
- Practice address
- 4920 Raeford Rd
Fayetteville, NC 28304-3142 - Phone
- (910) 585-8308
- NPI assigned
- Oct 6, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 7684 | NC | Primary |
Addresses
Primary practice location
4920 Raeford Rd
Fayetteville, NC 28304-3142
Mailing address
1002 Willow Dr Apt 26
Chapel Hill, NC 27514-2933
Phone (336) 847-0093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7684 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286323200000",
"number": "1114236346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1002 WILLOW DR APT 26",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275142933",
"telephone_number": "336-847-0093",
"fax_number": "208-246-2255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4920 RAEFORD RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043142",
"telephone_number": "910-585-8308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STACY",
"middle_name": "ALLIEOU",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-06",
"last_updated": "2010-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "7684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.