Provider Demographics
NPI:1437480720
Name:SWEENEY, DANA STACK (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:STACK
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:STACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2650
Mailing Address - Country:US
Mailing Address - Phone:617-663-7100
Mailing Address - Fax:
Practice Address - Street 1:120 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2650
Practice Address - Country:US
Practice Address - Phone:617-663-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist