Individual
STACEY LEA IRWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
294 HOSLEY AVE, TUPPER LAKE, NY 12986
(518) 359-3322
Mailing address
294 HOSLEY AVE, TUPPER LAKE, NY 12986-1555
(518) 359-3322
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005562
NY
Other
Enumeration date
06/24/2009
Last updated
02/06/2012
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