Provider Demographics
NPI:1336483650
Name:DYE, STEPHANIE MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:DYE
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 1:109 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13744-1054
Mailing Address - Country:US
Mailing Address - Phone:607-624-2383
Mailing Address - Fax:
Practice Address - Street 1:863 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1540
Practice Address - Country:US
Practice Address - Phone:607-722-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010501-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist