Provider Demographics
NPI:1528436946
Name:LIND, STACEY DIANNE-DENATALE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:DIANNE-DENATALE
Last Name:LIND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:D
Other - Last Name:DENATALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2945 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2549
Mailing Address - Country:US
Mailing Address - Phone:650-755-6500
Mailing Address - Fax:650-755-6565
Practice Address - Street 1:2945 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2549
Practice Address - Country:US
Practice Address - Phone:650-755-6500
Practice Address - Fax:650-755-6565
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist