Provider Demographics
NPI:1346521960
Name:STANLEY, EILEEN D (OTR)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:D
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MEDICAL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3102
Mailing Address - Country:US
Mailing Address - Phone:361-575-0681
Mailing Address - Fax:
Practice Address - Street 1:117 MEDICAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3102
Practice Address - Country:US
Practice Address - Phone:361-575-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106356225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics