Provider Demographics
NPI:1770874851
Name:AYERS, STEPHANIE CORIN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CORIN
Last Name:AYERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 SPAULDING DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3518
Mailing Address - Country:US
Mailing Address - Phone:607-207-5855
Mailing Address - Fax:
Practice Address - Street 1:332 BROAD ST
Practice Address - Street 2:A
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1345
Practice Address - Country:US
Practice Address - Phone:607-948-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007515-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant