Provider Demographics
NPI:1023317716
Name:STIMSON, THERESE MARY (OTR)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARY
Last Name:STIMSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 DORY CRSE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8229
Mailing Address - Country:US
Mailing Address - Phone:315-699-1001
Mailing Address - Fax:
Practice Address - Street 1:400 SANDERSON DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1644
Practice Address - Country:US
Practice Address - Phone:315-487-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002864-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist