Individual
MISS SHANA ELAYNE STAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 RAPP RD, ALBANY, NY 12203-4491
(518) 867-3061
Mailing address
47 MORNING GLORY WAY, SCHENECTADY, NY 12306-3338
(518) 355-0509
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007599-1
NY
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
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