Individual
STACIANN GARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23 MORTON ST, PORT JEFFERSON STATION, NY 11776-4012
(631) 291-7913
Mailing address
23 MORTON ST, PORT JEFFERSON STATION, NY 11776-4012
(631) 291-7913
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007163-01
NY
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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