Provider Demographics
NPI:1629785779
Name:GILLESPIE, STEPHANIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 3RD PL S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY SOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5206
Mailing Address - Country:US
Mailing Address - Phone:516-761-4254
Mailing Address - Fax:
Practice Address - Street 1:154 EASTLAKE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2399
Practice Address - Country:US
Practice Address - Phone:516-308-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist