Provider Demographics
NPI:1346676269
Name:LAURELLI, STEPHANIE (OT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAURELLI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 IRWIN CT
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2511
Mailing Address - Country:US
Mailing Address - Phone:516-668-2915
Mailing Address - Fax:
Practice Address - Street 1:7 IRWIN CT
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2511
Practice Address - Country:US
Practice Address - Phone:516-668-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004839-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist