Healthcare Provider Details

I. General information

NPI: 1700711595
Provider Name (Legal Business Name): STEPHANIE ANN COREA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

3391 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

V. Phone/Fax

Practice location:
  • Phone: 718-608-9170
  • Fax: 718-608-9179
Mailing address:
  • Phone: 718-608-9170
  • Fax: 718-608-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number031228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: