Provider Demographics
NPI:1114261369
Name:STAMBAUGH, LINDA W (MS OTR L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:W
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HAWTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9409
Mailing Address - Country:US
Mailing Address - Phone:610-395-0383
Mailing Address - Fax:
Practice Address - Street 1:130 HAWTHORNE CIR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9409
Practice Address - Country:US
Practice Address - Phone:610-395-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005075L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist