Individual
STACEY M COSTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
12005 TELEGRAPH RD, MEDINA, NY 14103-9678
(585) 721-1241
Mailing address
590 FISHERS STATION DR STE 130, VICTOR, NY 14564-9744
(585) 924-7207
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
006251-1
NY
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
09/29/2008
Last updated
02/21/2020
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