MEDICARE: LORI KLOIBER-STACO OTR, CHT

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	225XH1200X	Hand Occupational Therapist	006016	NY
2	225X00000X	Occupational Therapist	006016	NY

General Provider Information

NPI Number	:	1902328214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI KLOIBER-STACO OTR, CHT

Provider Business Mailing Address
First Line	:	2142 UTOPIA PKWY
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-4142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 W MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8365
Country	:	US
Telephone Number	:	631-647-9124
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	05/16/2019

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