Provider Demographics
NPI:1083923379
Name:STOCKDALE-FELLOWS, GWEN ANN (OTR)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:ANN
Last Name:STOCKDALE-FELLOWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ACADEMY STREET
Mailing Address - Street 2:NAPLES CENTRAL SCHOOL
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9583
Mailing Address - Country:US
Mailing Address - Phone:585-374-7950
Mailing Address - Fax:
Practice Address - Street 1:2 ACADEMY STREET
Practice Address - Street 2:NAPLES CENTRAL SCHOOL DISTRICT
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512
Practice Address - Country:US
Practice Address - Phone:585-374-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002594-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics