Provider Demographics
NPI:1598964058
Name:AMARAL, STACEY LORRAINE (COTA/ L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LORRAINE
Last Name:AMARAL
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 1:347 SOMERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2914
Mailing Address - Country:US
Mailing Address - Phone:617-201-6076
Mailing Address - Fax:
Practice Address - Street 1:347 SOMERVILLE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2914
Practice Address - Country:US
Practice Address - Phone:617-201-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1940224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant