Active NPI
Stacy Ray Eubanks
- Occupational Therapist
- Citra, FL
National Provider Identifier
1902314248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT18791
- Practice address
- 2555 E Highway 316
Citra, FL 32113-4570 - Phone
- (352) 817-0012
- NPI assigned
- Jan 22, 2018
- Last updated
- Jan 8, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT18791 | FL | Primary |
Addresses
Primary practice location
2555 E Highway 316
Citra, FL 32113-4570
Mailing address
2555 E Highway 316
Citra, FL 32113-4570
Phone (352) 817-0012
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610064000000",
"number": "1902314248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2555 E HIGHWAY 316",
"city": "CITRA",
"state": "FL",
"postal_code": "321134570",
"telephone_number": "352-817-0012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 E HIGHWAY 316",
"city": "CITRA",
"state": "FL",
"postal_code": "321134570",
"telephone_number": "352-817-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EUBANKS",
"first_name": "STACY",
"middle_name": "RAY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-22",
"last_updated": "2021-01-08",
"certification_date": "2021-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT18791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Citra, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.