MEDICARE: MRS. STACY LEE ROONEY MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	002877	CT

General Provider Information

NPI Number	:	1275873663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LEE ROONEY MOTR/L

Provider Business Mailing Address
First Line	:	55 TUNXIS AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2005
Country	:	US
Telephone Number	:	860-242-0703
Fax Number	:	860-242-4086

Provider Business Practice Location Address
First Line	:	55 TUNXIS AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2005
Country	:	US
Telephone Number	:	860-242-0703
Fax Number	:	860-242-4086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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