Provider Demographics
NPI:1740775642
Name:SOLUSTRI, STEFANIA MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEFANIA
Middle Name:MARIA
Last Name:SOLUSTRI
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 1:6 FARMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1151
Mailing Address - Country:US
Mailing Address - Phone:203-395-5363
Mailing Address - Fax:
Practice Address - Street 1:6949 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6304
Practice Address - Country:US
Practice Address - Phone:203-261-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist