Provider Demographics
NPI:1316765514
Name:BRENTNALL, STEPHANIE ELEANOR (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELEANOR
Last Name:BRENTNALL
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 1:2680 STATE ROUTE 245 APT 3
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561-9733
Mailing Address - Country:US
Mailing Address - Phone:845-863-3895
Mailing Address - Fax:
Practice Address - Street 1:3 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1081
Practice Address - Country:US
Practice Address - Phone:315-536-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist