Individual
CARLOS T STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 600, 167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1373
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153821
—
AZ
Enumeration date
01/25/2007
Last updated
07/08/2007
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