Provider Demographics
NPI:1043420946
Name:STANLEY, KATHY D (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:D
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 TURNBULL BAY RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5972
Mailing Address - Country:US
Mailing Address - Phone:386-663-7370
Mailing Address - Fax:
Practice Address - Street 1:900 LPGA BLVD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3113
Practice Address - Country:US
Practice Address - Phone:386-226-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist