Provider Demographics
NPI:1104436849
Name:COLELLA, STEPHANIE KAY (OTR/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:COLELLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DWIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-3405
Mailing Address - Country:US
Mailing Address - Phone:978-604-1569
Mailing Address - Fax:
Practice Address - Street 1:546 CHICOPEE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2148
Practice Address - Country:US
Practice Address - Phone:413-536-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist