Provider Demographics
NPI:1508048364
Name:WONG, STEPHANIE JO DAPICE (DPT, OTR)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO DAPICE
Last Name:WONG
Suffix:
Gender:F
Credentials:DPT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2237
Mailing Address - Country:US
Mailing Address - Phone:516-263-3188
Mailing Address - Fax:
Practice Address - Street 1:53 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8756
Practice Address - Country:US
Practice Address - Phone:516-263-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0165841225100000X
NY0048221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist