Provider Demographics
NPI:1780823880
Name:STEFANIK, STACY MARLA (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MARLA
Last Name:STEFANIK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 BROADVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1216
Mailing Address - Country:US
Mailing Address - Phone:724-224-9200
Mailing Address - Fax:
Practice Address - Street 1:1050 BROADVIEW BLVD
Practice Address - Street 2:
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1216
Practice Address - Country:US
Practice Address - Phone:724-224-9200
Practice Address - Fax:724-224-1834
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003369L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant