Provider Demographics
NPI:1528586070
Name:DEOLIVEIRA, STACY OLIVIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:OLIVIA
Last Name:DEOLIVEIRA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TABER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2235
Mailing Address - Country:US
Mailing Address - Phone:508-997-0791
Mailing Address - Fax:
Practice Address - Street 1:19 TABER ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2235
Practice Address - Country:US
Practice Address - Phone:508-997-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3701224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant