Healthcare Provider Details

I. General information

NPI: 1053671784
Provider Name (Legal Business Name): STEPHANIE SCOTTO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 RADCLIFF RD
STATEN ISLAND NY
10305-2611
US

IV. Provider business mailing address

83 RADCLIFF RD
STATEN ISLAND NY
10305-2611
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-3995
  • Fax:
Mailing address:
  • Phone: 917-284-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number071256-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number017256-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number017256-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: