Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Stacey Wallace, OTRL

Individual provider Occupational Therapist · NPI 1043951957

Stacey Wallace, OTRL is an Occupational Therapist in Private Practice in Midland, Michigan. Qualified in 2020, 6 years ago. Practices with Powerback Rehabilitation LLC, a 616-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
6
Licensed in
MI
In the registry since
2022
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Practice location Address checks out

5600 Waldo Ave
Midland, MI 48642-6438
Phone: (989) 575-3255
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 5201011236 (MI)

Record details

NPI number1043951957
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTRL
Sole proprietorNo
NPI enumeratedApril 5, 2022
Last updated in NPPESApril 5, 2022
Certification dateApril 4, 2022
Mailing address3326 Binscarth Ave, Saginaw, MI 48602-3203

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Powerback Rehabilitation Llc — 616 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Midland