Stacey Gordon Connelly, OTRL CHT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT00892 Issued in RI

Practice address

164 Summit Ave
Providence, RI 02906-2853

Phone

(401) 793-2500

NPI assigned

Apr 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Stacey Lynn Gordon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rhode Island Hand Center, P.C.

  • Orthopaedic Hand Surgery Physician
  • Cranston, RI
  • NPI 1841249935
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174580872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 RIVER AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029083438",
            "telephone_number": "401-861-2976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "STACEY",
        "middle_name": "GORDON",
        "credential": "OTRL CHT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "RI",
            "license": "OT00892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF RI",
            "identifier": "00000291880",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP OF RI",
            "identifier": "001072",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "GORDON",
            "middle_name": "LYNN",
            "credential": "OTRL CHT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kimberly Conklin
• Steve Conlan, LCSW
• Madison Conley, MHCA
• Lauren Caroline Connell
• William Daniel Connell III
• Timothy Gerard Connelly, D.O.
• Amanda Connerton, PSYD
• Gina M Connerton, MLP-NP
• Julie Connolly, LCSW
• William Joseph Connolly

• Occupational Therapist in Providence, RI
• Providers in Providence, RI by specialty
• Occupational Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.