Provider Demographics
NPI:1134527278
Name:CALIXTE, STEPHELENECIE
Entity type:Individual
Prefix:
First Name:STEPHELENECIE
Middle Name:
Last Name:CALIXTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHELENECIE
Other - Middle Name:
Other - Last Name:CALIXTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:261 LENOX RD
Mailing Address - Street 2:APT 3N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2183
Mailing Address - Country:US
Mailing Address - Phone:347-622-9072
Mailing Address - Fax:
Practice Address - Street 1:1651 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5849
Practice Address - Country:US
Practice Address - Phone:718-998-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019315225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation