=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366777476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE MANOLESCU STALNAKER M.S., OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2009
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4279 CRESTED BUTTE RUN
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13215-1355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-569-9308
-----------------------------------------------------
Fax | 315-295-2579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 DWIGHT AVE
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13323-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-368-4072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XN1300X
-----------------------------------------------------
Taxonomy Name | Neurorehabilitation Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------