Provider Demographics
NPI:1528782497
Name:PLUMBO, STACY CATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:CATHERINE
Last Name:PLUMBO
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 1:819 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1104
Mailing Address - Country:US
Mailing Address - Phone:717-201-1207
Mailing Address - Fax:
Practice Address - Street 1:207 W SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2054
Practice Address - Country:US
Practice Address - Phone:267-865-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist