Provider Demographics
NPI:1790023232
Name:STANLEY, KAREN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:SASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 TESCONI CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4676
Mailing Address - Country:US
Mailing Address - Phone:707-546-9160
Mailing Address - Fax:707-546-1338
Practice Address - Street 1:340 TESCONI CIR STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4676
Practice Address - Country:US
Practice Address - Phone:707-546-9160
Practice Address - Fax:707-546-1338
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10796225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist