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

Stacy J Gardner, OT

Individual provider Pediatric Occupational Therapist · NPI 1669239133

Stacy J Gardner, OT is a Pediatric Occupational Therapist in Shelley, Idaho. Licensed in Idaho. Registered with an NPI since 2024.

Licensed in
ID
In the registry since
2024
What do these letters mean?
OT — Occupational Therapist
Helps people regain the skills needed for daily living and work.

See every abbreviation used in this directory →

Practice location Address checks out

650 N State St Ste 5
Shelley, ID 83274-4900
Phone: (208) 428-6079
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Occupational Therapist (primary) Taxonomy 225XP0200X · Licence OT988 (ID)

Record details

NPI number1669239133
Entity typeIndividual (Type 1)
GenderFemale
Credentials OT
Sole proprietorNo
NPI enumeratedMarch 1, 2024
Last updated in NPPESMarch 1, 2024
Certification dateMarch 1, 2024
Mailing address650 N State St Ste 5, Shelley, ID 83274-4900