Provider Demographics
NPI:1659423598
Name:STELIK, TODD STEPHEN (OTRL)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:STEPHEN
Last Name:STELIK
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BROAD ST # B
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2544
Mailing Address - Country:US
Mailing Address - Phone:860-848-4180
Mailing Address - Fax:860-574-9393
Practice Address - Street 1:601 BROAD ST # B
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2544
Practice Address - Country:US
Practice Address - Phone:860-848-4180
Practice Address - Fax:860-574-9393
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTTRICAREOther061533801
RIBCBS RIOther27989-7
CTCIGNAOther1915336
CTUNITED HEALTHCAREOther061533801
CTANTHEM BCBSOther130002139CT02
CT670000081Medicare ID - Type UnspecifiedMEDICARE