Provider Demographics
NPI:1063664316
Name:STRUBLE, STEPHANIE (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:PEDIATRIC OT SOLUTIONS
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930
Mailing Address - Country:US
Mailing Address - Phone:845-827-5360
Mailing Address - Fax:845-827-5361
Practice Address - Street 1:615 RTE 32
Practice Address - Street 2:PEDIATRIC OT SOLUTIONS
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930
Practice Address - Country:US
Practice Address - Phone:845-827-5360
Practice Address - Fax:845-827-5361
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006907-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant