Individual
KELLY A STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L, C/NDT
Contact information
Practice address
171 MADISON AVE FL 5, NEW YORK, NY 10016
(212) 400-0383
Mailing address
30 1ST ST # 2, BROOKLYN, NY 11231-5002
(516) 860-8496
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
016667-1
NY
225XP0200X
Pediatric Occupational Therapist
Primary
016667-1
NY
Other
Enumeration date
03/15/2011
Last updated
11/05/2018
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