Provider Demographics
NPI:1174244123
Name:STANLEY, EMILY ROSE (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 STORY ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929-1143
Mailing Address - Country:US
Mailing Address - Phone:978-590-6352
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK STE 1
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6503
Practice Address - Country:US
Practice Address - Phone:781-305-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist