Provider Demographics
NPI:1275873663
Name:ROONEY, STACY LEE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEE
Last Name:ROONEY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TUNXIS AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2005
Mailing Address - Country:US
Mailing Address - Phone:860-242-0703
Mailing Address - Fax:860-242-4086
Practice Address - Street 1:55 TUNXIS AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2005
Practice Address - Country:US
Practice Address - Phone:860-242-0703
Practice Address - Fax:860-242-4086
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist