Provider Demographics
NPI:1609993716
Name:STEWART, WINDEL B (COTA)
Entity Type:Individual
Prefix:MR
First Name:WINDEL
Middle Name:B
Last Name:STEWART
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 MICKLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1614
Mailing Address - Country:US
Mailing Address - Phone:845-729-0882
Mailing Address - Fax:
Practice Address - Street 1:1870 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-0000
Practice Address - Country:US
Practice Address - Phone:718-652-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5954797UPD224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant