Individual
MAUREEN STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
559 ATLANTIC AVE, EAST ROCKAWAY, NY 11518-1530
(516) 241-3684
Mailing address
42 WACHUSETTS ST, ROCKVILLE CENTRE, NY 11570-1934
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
015582
NY
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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