Healthcare Provider Details

I. General information

NPI: 1750978664
Provider Name (Legal Business Name): STEPHANIE GELLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2020
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 MERRICK RD
SEAFORD NY
11783-2833
US

IV. Provider business mailing address

3559 MERRICK RD
SEAFORD NY
11783-2833
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-4021
  • Fax:
Mailing address:
  • Phone: 516-639-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: