Provider Demographics
NPI:1205662731
Name:STARSIAK, ISABELLA MARIE (OT R/L)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MARIE
Last Name:STARSIAK
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5453 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2007
Mailing Address - Country:US
Mailing Address - Phone:315-939-2654
Mailing Address - Fax:
Practice Address - Street 1:929 YORK ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3929
Practice Address - Country:US
Practice Address - Phone:315-939-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029448225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics