Provider Demographics
NPI:1720263130
Name:STANLEY, CARROL LEA III (FOSTER MOTHER)
Entity type:Individual
Prefix:MS
First Name:CARROL
Middle Name:LEA
Last Name:STANLEY
Suffix:III
Gender:F
Credentials:FOSTER MOTHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 DEL HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2907
Mailing Address - Country:US
Mailing Address - Phone:405-672-2914
Mailing Address - Fax:405-672-2914
Practice Address - Street 1:713 DEL HAVEN DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2907
Practice Address - Country:US
Practice Address - Phone:405-672-2914
Practice Address - Fax:405-672-2914
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care