Provider Demographics
NPI:1205089869
Name:FRASIER, STACEY LYN
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYN
Last Name:FRASIER
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 1:7 JESSICA TRCE
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-3220
Mailing Address - Country:US
Mailing Address - Phone:518-466-3339
Mailing Address - Fax:
Practice Address - Street 1:7 JESSICA TRCE
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-3220
Practice Address - Country:US
Practice Address - Phone:518-580-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7876-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist