Provider Demographics
NPI:1235662172
Name:STANLEY, STEVEN WAYNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:STANLEY
Suffix:
Gender:M
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 1:47 WINSHIP ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3331
Mailing Address - Country:US
Mailing Address - Phone:860-301-2664
Mailing Address - Fax:
Practice Address - Street 1:8 LEWIS POINT RD
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-5613
Practice Address - Country:US
Practice Address - Phone:508-759-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist