Provider Demographics
NPI:1851627814
Name:NEWBURY, STACY D (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:NEWBURY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16199 N 182ND LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-6622
Mailing Address - Country:US
Mailing Address - Phone:623-584-8025
Mailing Address - Fax:
Practice Address - Street 1:1818 E SKY HARBOR CIR N
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-3407
Practice Address - Country:US
Practice Address - Phone:602-523-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist