Provider Demographics
NPI:1942752423
Name:TAYLOR, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 FRANKLIN ST
Mailing Address - Street 2:C/O CDPC - SCSC 1ST FL SUITE 1
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2041
Mailing Address - Country:US
Mailing Address - Phone:518-374-3403
Mailing Address - Fax:
Practice Address - Street 1:426 FRANKLIN ST
Practice Address - Street 2:C/O CDPC - SCSC 1ST FL SUITE 1
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2041
Practice Address - Country:US
Practice Address - Phone:518-374-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004395-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant