Provider Demographics
NPI:1316006125
Name:CARIELLO, STACY (MS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CARIELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 W MESETO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7559
Mailing Address - Country:US
Mailing Address - Phone:609-439-7678
Mailing Address - Fax:
Practice Address - Street 1:506 W MESETO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-7559
Practice Address - Country:US
Practice Address - Phone:609-439-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7275225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist