Diane M Stacker, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

2505 E Jefferson Blvd
South Bend, IN 46615-2635

Phone

(574) 289-4831

Fax

(574) 234-2075

NPI assigned

May 1, 2007

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

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1497976195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1049",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466241049",
            "telephone_number": "574-289-4831",
            "fax_number": "574-234-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152635",
            "telephone_number": "574-289-4831",
            "fax_number": "574-234-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKER",
        "first_name": "DIANE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "O.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ritchie St-Jean, RBT
• St. Joseph Co. Airport Authority
• St. Joseph County Auditor
• Susan M St. Ville, PH.D., MSW, LCSW
• Christine F Stacey, LCSW
• Samantha Morgan Stacy
• Jack Staddon, M.D., PH.D.
• Kaleigh Renee Stafford
• Cheryl Ann Stahl, FNP-BC
• Madelyn Stahl, RPH

• Occupational Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.