Provider Demographics
NPI:1255581310
Name:STUBECKI, LAURA JEAN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:STUBECKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 N LYNN ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1233
Mailing Address - Country:US
Mailing Address - Phone:845-827-5360
Mailing Address - Fax:845-827-5361
Practice Address - Street 1:1406 KINGS HWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-3009
Practice Address - Country:US
Practice Address - Phone:845-827-5360
Practice Address - Fax:845-827-5361
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010261-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics