Provider Demographics
NPI:1790839462
Name:DYER, STACIA LYNN (OTR CHT)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:LYNN
Last Name:DYER
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BARRY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1723
Mailing Address - Country:US
Mailing Address - Phone:973-586-4023
Mailing Address - Fax:
Practice Address - Street 1:19 BARRY DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1723
Practice Address - Country:US
Practice Address - Phone:973-586-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00178800225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand