Provider Demographics
NPI:1437593282
Name:O'CONNOR, STACEY M (DPT)
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 GOFFLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3037
Mailing Address - Country:US
Mailing Address - Phone:973-949-3927
Mailing Address - Fax:
Practice Address - Street 1:599 GOFFLE HILL RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3037
Practice Address - Country:US
Practice Address - Phone:973-949-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01348800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist