Stacy Elaine Mattox, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTR1458 Issued in AR

Practice address

1807 W Moline St
Malvern, AR 72104-2645

Phone

(501) 467-3166

Fax

(501) 467-3161

NPI assigned

Jan 16, 2007

Last updated

May 13, 2010By the provider in NPPES

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 identifiers 1

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273708800000",
    "number": "1801947510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 RIVER ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720155024",
            "telephone_number": "501-240-9867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 W MOLINE ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042645",
            "telephone_number": "501-467-3166",
            "fax_number": "501-467-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOX",
        "first_name": "STACY",
        "middle_name": "ELAINE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AR",
            "license": "OTR1458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136251721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Malvern, AR
• Providers in Malvern, AR by specialty
• Occupational Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.