Provider Demographics
NPI:1285956607
Name:CRESCITELLI, STACY JILL (OTR)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JILL
Last Name:CRESCITELLI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 NW 60TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2523
Mailing Address - Country:US
Mailing Address - Phone:954-346-1476
Mailing Address - Fax:954-575-0291
Practice Address - Street 1:10255 NW 60TH PL
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2523
Practice Address - Country:US
Practice Address - Phone:954-346-1476
Practice Address - Fax:954-575-0291
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 3233225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics