Provider Demographics
NPI:1801033592
Name:ANDRESKI, STEPHEN JOHN JR (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:ANDRESKI
Suffix:JR
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:27 W HITE CT
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5623
Mailing Address - Country:US
Mailing Address - Phone:518-355-0617
Mailing Address - Fax:
Practice Address - Street 1:27 W HITE CT
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5623
Practice Address - Country:US
Practice Address - Phone:518-355-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010943-1225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist