Individual
STACEY ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
17923 144TH AVE, JAMAICA, NY 11434-5923
(646) 234-4929
Mailing address
17923 144TH AVE, JAMAICA, NY 11434-5923
(646) 234-4929
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006987
NY
Other
Enumeration date
02/26/2008
Last updated
02/26/2008
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