Provider Demographics
NPI:1932354842
Name:DESTEFANO, LAURIE ANN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:DESTEFANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:MASSEY-DESTEFANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-576-5292
Mailing Address - Fax:914-576-3983
Practice Address - Street 1:20 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:914-576-3983
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007620-1225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation