Provider Demographics
NPI:1457633810
Name:FRIEDMAN, STACEY BLAIR (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:BLAIR
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LOCUST ST
Mailing Address - Street 2:APT 20J
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4223
Mailing Address - Country:US
Mailing Address - Phone:610-574-8871
Mailing Address - Fax:
Practice Address - Street 1:1420 LOCUST ST
Practice Address - Street 2:APT 20J
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4223
Practice Address - Country:US
Practice Address - Phone:610-574-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011329225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist