=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427198472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AILEEN M STEWART OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 ANTHONY LN
-----------------------------------------------------
City | NORTH BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11703-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-661-6263
-----------------------------------------------------
Fax | 631-661-4134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ANTHONY LN
-----------------------------------------------------
City | NORTH BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11703-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-661-6263
-----------------------------------------------------
Fax | 631-661-4134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0070121
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------