Provider Demographics
NPI:1710409537
Name:STOKLOSA, DEVIN ELISE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DEVIN
Middle Name:ELISE
Last Name:STOKLOSA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:ELISE
Other - Last Name:BOSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 COTTAGE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8654
Mailing Address - Country:US
Mailing Address - Phone:585-797-9366
Mailing Address - Fax:585-486-1230
Practice Address - Street 1:700 COTTAGE BROOK LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8654
Practice Address - Country:US
Practice Address - Phone:585-797-9366
Practice Address - Fax:585-486-1230
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist