Healthcare Provider Details

I. General information

NPI: 1033042734
Provider Name (Legal Business Name): LAVENDER LANE OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 BRIDGE VIEW DR
NEW FAIRFIELD CT
06812-4010
US

IV. Provider business mailing address

13 BRIDGE VIEW DR
NEW FAIRFIELD CT
06812-4010
US

V. Phone/Fax

Practice location:
  • Phone: 203-470-3060
  • Fax:
Mailing address:
  • Phone: 203-470-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CICELY REICH-STANIULIS
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 203-470-3060