Individual provider · Type 1 NPI

Stacey Stark

Occupational Therapist · Shoreview, MN

NPI number 1104755511 Active

Practice location

4570 Victoria St N
Shoreview, MN 55126-5800

Call (651) 621-6000 Map

Specialties and licenses

TaxonomyCodeLicense
Occupational Therapist Primary 225X00000XNone listed

Occupational Therapist: An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork…

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About NPI 1104755511

Stacey Stark's National Provider Identifier is 1104755511, issued on May 14, 2026. The primary taxonomy on file is Occupational Therapist (225X00000X), and the practice location is in Shoreview, MN. The record was last updated on May 14, 2026.