Provider Demographics
NPI:1225345531
Name:STALNAKER, KELLY B (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:B
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ELM ST
Mailing Address - Street 2:GROTON ELEMENTARY SCHOOL
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1124
Mailing Address - Country:US
Mailing Address - Phone:607-898-5853
Mailing Address - Fax:
Practice Address - Street 1:516 ELM ST
Practice Address - Street 2:GROTON ELEMENTARY SCHOOL
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1124
Practice Address - Country:US
Practice Address - Phone:607-898-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist