MEDICARE: MRS. STACEY V MISLAVSKY MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0146401	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0146401	OTHER	NY	NEW YORK DEPARTMENT OF EDUCATION OCCUPATIONAL THERAPY LICENSE

General Provider Information

NPI Number	:	1780991950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY V MISLAVSKY MS, OTR/L

Provider Business Mailing Address
First Line	:	425 MAIN ST
Second Line	:	APT 11K
City	:	NEW YORK
State	:	NY
Zip	:	10044-0238
Country	:	US
Telephone Number	:	443-695-3392
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 MAIN ST
Second Line	:	APT 11K
City	:	NEW YORK
State	:	NY
Zip	:	10044-0238
Country	:	US
Telephone Number	:	443-695-3392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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