Provider Demographics
NPI:1366596017
Name:STANLEY, DANIEL C (OTR, CHT, MPA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:STANLEY
Suffix:
Gender:M
Credentials:OTR, CHT, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3524
Mailing Address - Country:US
Mailing Address - Phone:941-484-5500
Mailing Address - Fax:941-484-5510
Practice Address - Street 1:744 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3524
Practice Address - Country:US
Practice Address - Phone:941-484-5500
Practice Address - Fax:941-484-5510
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065441225XH1200X
FLOT20956225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQU7142OtherEMPIRE BC/BS (NEW PALTZ)
NY000000116960OtherGHI HMO #
NYQU7141OtherEMPIRE BC/BS (NEW WINDSR)
NY368063OtherMVP #
NY141796305OtherTAX ID#
NYQU576KC101Medicare PIN