Connelly, Stacey Gordon

Connelly, Stacey Gordon is an individual health care provider with primary practice located at 164 Summit Ave , Providence RI 02906-2853. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Connelly, Stacey Gordon can be contacted via phone (401) 793-2500.

Contact Information

Primary practice address
164 Summit Ave Providence RI 02906-2853
Phone: (401) 793-2500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OT00892 Rhode Island

Profile Details

NPI number 1174580872
LBN Legal business name Connelly, Stacey Gordon
Credentials OTRL CHT
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174580872 NPPES
Rhode Island Other 00000291880 BCBS OF RI
Rhode Island Other 001072 BCBS OF RI

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