Stacey Latrice Willis, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2827 Issued in TN

Practice address

4513 Jon Stone LN
Arlington, TN 38002-7536

Phone

(901) 461-0621

NPI assigned

Apr 26, 2012

Sex

Female

Sole proprietor

Yes

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)

Enrolled

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1962760066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4513 JON STONE LN",
            "city": "ARLINGTON",
            "state": "TN",
            "postal_code": "380027536",
            "telephone_number": "901-461-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4513 JON STONE LN",
            "city": "ARLINGTON",
            "state": "TN",
            "postal_code": "380027536",
            "telephone_number": "901-461-0621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "STACEY",
        "middle_name": "LATRICE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-26",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "2827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber McCaleb Williams
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• Women'S Heatlh Care Associates
• Chasity Vashon Wooten, RN
• Nicholas Wyrosdick, DPT
• Youth Villages, Inc.

• Occupational Therapist in Arlington, TN
• Providers in Arlington, TN by specialty
• Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; 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.