Provider Demographics
NPI:1669635900
Name:STELMACK, AMIE ANN (MED)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:ANN
Last Name:STELMACK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:221 BOSTON POST RD E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3527
Mailing Address - Country:US
Mailing Address - Phone:508-624-0304
Mailing Address - Fax:
Practice Address - Street 1:221 BOSTON POST RD E
Practice Address - Street 2:SUITE 150
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3527
Practice Address - Country:US
Practice Address - Phone:508-624-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA419486222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA419486OtherDEPARTMENT OF EDUCATION / COMMONWEALTH OF MA