MEDICARE: STILLWATER OCCUPATIONAL THERAPY & SOCIAL WORK GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154384287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLWATER OCCUPATIONAL THERAPY & SOCIAL WORK GROUP, PLLC

Provider Business Mailing Address
First Line	:	160 HOWELLS RD
Second Line	:	SUITE 2
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-647-7885
Fax Number	:	631-647-7893

Provider Business Practice Location Address
First Line	:	160 HOWELLS RD
Second Line	:	SUITE 2
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-647-7885
Fax Number	:	631-647-7893

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAE R ZYSMAN
Credential	:
Telephone Number	:	631-647-7885

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	09/11/2025

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