Page Stacey Worrells

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

385 Sherwood Ave
Satellite Beach, FL 32937-3037

Phone

(321) 634-3688

Fax

(321) 504-0955

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1114298304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 SHERWOOD AVE",
            "city": "SATELLITE BEACH",
            "state": "FL",
            "postal_code": "329373037",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 SHERWOOD AVE",
            "city": "SATELLITE BEACH",
            "state": "FL",
            "postal_code": "329373037",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORRELLS",
        "first_name": "PAGE",
        "middle_name": "STACEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004433600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael David Ville, DC
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• Nicole Williams, PHARMD
• Ernie Wong, PHARM.D.
• Jess Yates, D.M.D.

• Developmental Therapist in Satellite Beach, FL
• Providers in Satellite Beach, FL by specialty
• Developmental Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.