Provider Demographics
NPI:1124621529
Name:STANSBERRY, BUSISIWE B (OT)
Entity type:Individual
Prefix:
First Name:BUSISIWE
Middle Name:B
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BUSISIWE
Other - Middle Name:B
Other - Last Name:MALINKI-ODUSOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5025 E WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7439
Mailing Address - Country:US
Mailing Address - Phone:602-773-5775
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGTON ST STE 212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7439
Practice Address - Country:US
Practice Address - Phone:602-773-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty