Stacy Lynn Medina, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

259914 Issued in OR

Practice address

1680 Molalla Ave.
Oregon City, OR 97045

Phone

(503) 655-2588

Fax

(503) 655-8791

NPI assigned

Sep 20, 2010

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

Other names 1

• Ms. Stacy Lynn Dicristofano Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284940800000",
    "number": "1154639516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY",
            "address_2": "STE. 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97222",
            "telephone_number": "971-206-5200",
            "fax_number": "971-206-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 MOLALLA AVE.",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "97045",
            "telephone_number": "503-655-2588",
            "fax_number": "503-655-8791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-20",
        "last_updated": "2010-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "259914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "DICRISTOFANO",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Becky McVicker-Young
• Thomas P McWeeney, MD
• Jay Mead, M.D.
• Jessica Kealani Mealer
• Erin Medina Heins
• Tricia Meeker, RNC, IBCLC
• Ronald H Meier, OD
• Suzette JM Meier, RN
• Shelley L Mellor
• Caley Melton, MSW

• Occupational Therapist in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.

Verify at the official NPI Registry.