Active NPI
Rachael M Stacy, CTRS
- Recreation Therapist
- Allendale, MI
National Provider Identifier
1508104936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- Practice address
- 11339 56TH Ave
Allendale, MI 49401-9158 - Phone
- (209) 224-1054
- Fax
- (855) 207-3270
- NPI assigned
- Jan 18, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | Primary |
Addresses
Primary practice location
11339 56TH Ave
Allendale, MI 49401-9158
Mailing address
11339 56TH Ave
Allendale, MI 49401-9158
Phone (209) 224-1054
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358467200000",
"number": "1508104936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11339 56TH AVE",
"city": "ALLENDALE",
"state": "MI",
"postal_code": "494019158",
"telephone_number": "209-224-1054",
"fax_number": "855-207-3270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11339 56TH AVE",
"city": "ALLENDALE",
"state": "MI",
"postal_code": "494019158",
"telephone_number": "209-224-1054",
"fax_number": "855-207-3270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "RACHAEL",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-18",
"last_updated": "2013-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allendale, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.