Provider Demographics
NPI:1457491888
Name:POPE, STEPHANIE S (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:S
Last Name:POPE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LYON PL
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6105
Mailing Address - Country:US
Mailing Address - Phone:315-732-0723
Mailing Address - Fax:
Practice Address - Street 1:4290 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5314
Practice Address - Country:US
Practice Address - Phone:315-707-7500
Practice Address - Fax:315-624-0192
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008233-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist