Provider Demographics
NPI:1780092676
Name:SANTOSTEFANO, NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SANTOSTEFANO
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 1:117 WHITLOCK CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7938
Mailing Address - Country:US
Mailing Address - Phone:732-637-8549
Mailing Address - Fax:
Practice Address - Street 1:2 PARK PLACE
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852
Practice Address - Country:US
Practice Address - Phone:732-274-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00650300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist