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:
Health care specialties
Specialty | Code | License # | 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 17 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1174580872 | NPPES |
Rhode Island | Other | 00000291880 | BCBS OF RI |
Rhode Island | Other | 001072 | BCBS OF RI |
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