Provider Demographics
NPI:1891005120
Name:HOLLEY, STEPHANIE TRIOLO (OTL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TRIOLO
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TOWNLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027
Mailing Address - Country:US
Mailing Address - Phone:518-384-1299
Mailing Address - Fax:
Practice Address - Street 1:18 TOWNLEY DRIVE
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027
Practice Address - Country:US
Practice Address - Phone:518-384-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000213-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics