Provider Demographics
NPI:1306183124
Name:ROW, STACEY DENISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DENISE
Last Name:ROW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 ELM ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2801
Mailing Address - Country:US
Mailing Address - Phone:610-781-7059
Mailing Address - Fax:
Practice Address - Street 1:17028 CADBURY CIR
Practice Address - Street 2:UNIT 1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-7022
Practice Address - Country:US
Practice Address - Phone:302-645-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001239224Z00000X
PAOP006926224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant