Provider Demographics
NPI:1033543848
Name:DALBY, STACEY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:DALBY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:BACKSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:6330 N FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4753
Practice Address - Country:US
Practice Address - Phone:574-247-4071
Practice Address - Fax:574-204-2192
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005291A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist