Provider Demographics
NPI:1760860043
Name:STANFA, SUZANNE WALD (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:WALD
Last Name:STANFA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:STANFA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:103 HENRY CT
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4982
Mailing Address - Country:US
Mailing Address - Phone:919-259-2549
Mailing Address - Fax:844-652-8088
Practice Address - Street 1:103 HENRY CT
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4982
Practice Address - Country:US
Practice Address - Phone:919-259-2549
Practice Address - Fax:844-652-8088
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4151225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics