Provider Demographics
NPI:1649550575
Name:SCALISI, STACIE L (COTA)
Entity type:Individual
Prefix:MISS
First Name:STACIE
Middle Name:L
Last Name:SCALISI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRI LAN AVE
Mailing Address - Street 2:APT #1
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2727
Mailing Address - Country:US
Mailing Address - Phone:518-588-4185
Mailing Address - Fax:
Practice Address - Street 1:11 BRI LAN AVE
Practice Address - Street 2:APT #1
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2727
Practice Address - Country:US
Practice Address - Phone:518-588-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007899-1224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification