Provider Demographics
NPI:1952923781
Name:STANLEY, KRAIG SCOTT (L/COTA)
Entity Type:Individual
Prefix:
First Name:KRAIG
Middle Name:SCOTT
Last Name:STANLEY
Suffix:
Gender:M
Credentials:L/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 E CIELO AZUL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8419
Mailing Address - Country:US
Mailing Address - Phone:623-332-9178
Mailing Address - Fax:
Practice Address - Street 1:1594 E CIELO AZUL WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-8419
Practice Address - Country:US
Practice Address - Phone:623-332-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ046823224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant