Provider Demographics
NPI:1437533957
Name:LADD, STEPHANIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FENOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2543
Mailing Address - Country:US
Mailing Address - Phone:631-252-4853
Mailing Address - Fax:
Practice Address - Street 1:64 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2543
Practice Address - Country:US
Practice Address - Phone:631-252-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008689224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant