Provider Demographics
NPI:1316288061
Name:STAMOS, JUDITH A (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:A
Last Name:STAMOS
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 1:1 ACKERLY TER
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2860
Mailing Address - Country:US
Mailing Address - Phone:631-375-7234
Mailing Address - Fax:
Practice Address - Street 1:1 ACKERLY TER
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2860
Practice Address - Country:US
Practice Address - Phone:631-375-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist