Provider Demographics
NPI:1417599739
Name:CAVALIERI, STEPHANIE ELLEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:CAVALIERI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELLEN
Other - Last Name:KIRGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:205 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2006
Mailing Address - Country:US
Mailing Address - Phone:631-873-8379
Mailing Address - Fax:
Practice Address - Street 1:212 BLUE POINT AVE
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-1204
Practice Address - Country:US
Practice Address - Phone:631-472-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024120225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist