Provider Demographics
NPI:1902122773
Name:CARITHERS, STACIE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CARITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2002
Mailing Address - Country:US
Mailing Address - Phone:412-531-0168
Mailing Address - Fax:412-531-0181
Practice Address - Street 1:1320 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2002
Practice Address - Country:US
Practice Address - Phone:412-531-0168
Practice Address - Fax:412-531-0181
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016170225X00000X
AZ006595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist