Provider Demographics
NPI:1992764583
Name:STACY LABAR THERAPY, LLC
Entity type:Organization
Organization Name:STACY LABAR THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-886-5348
Mailing Address - Street 1:11154 HURON ST
Mailing Address - Street 2:#101
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2329
Mailing Address - Country:US
Mailing Address - Phone:303-886-5348
Mailing Address - Fax:303-562-2415
Practice Address - Street 1:11154 HURON ST
Practice Address - Street 2:#101
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2329
Practice Address - Country:US
Practice Address - Phone:303-886-5348
Practice Address - Fax:303-562-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1035295225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89832337Medicaid
CO52605272Medicaid