Provider Demographics
NPI:1083623896
Name:STEPHANIE C SPINELLI AND ASSOCIATES
Entity Type:Organization
Organization Name:STEPHANIE C SPINELLI AND ASSOCIATES
Other - Org Name:DISTINCTIVE PEDIATRIC THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CASERTA
Authorized Official - Last Name:SPINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:407-896-1152
Mailing Address - Street 1:22 LAKE BEAUTY DR STE 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2040
Mailing Address - Country:US
Mailing Address - Phone:407-896-1152
Mailing Address - Fax:407-872-3014
Practice Address - Street 1:427 N MAGNOLIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1524
Practice Address - Country:US
Practice Address - Phone:407-896-1152
Practice Address - Fax:407-872-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2265418OtherAETNA HM0
FL5410590OtherAETNA PPO
FL882631500Medicaid
FLZ5844OtherBLUE CROSS BLUE SHIELD