Provider Demographics
NPI:1780991950
Name:MISLAVSKY, STACEY V (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:V
Last Name:MISLAVSKY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MAIN ST
Mailing Address - Street 2:APT 11K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0238
Mailing Address - Country:US
Mailing Address - Phone:443-695-3392
Mailing Address - Fax:
Practice Address - Street 1:425 MAIN ST
Practice Address - Street 2:APT 11K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0238
Practice Address - Country:US
Practice Address - Phone:443-695-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0146401OtherNEW YORK DEPARTMENT OF EDUCATION OCCUPATIONAL THERAPY LICENSE