Stacey M Costich, OTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

Practice address

12005 Telegraph Rd
Medina, NY 14103-9678

Phone

(585) 721-1241

NPI assigned

Sep 29, 2008

Last updated

Feb 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Western New York Speech-Language Pathology, OT, and PT Consultants

  • Early Intervention Provider Agency
  • Victor, NY
  • NPI 1386812550

  Specialist

  NPD (past)

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1497905251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FISHERS STATION DR STE 130",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649744",
            "telephone_number": "585-924-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12005 TELEGRAPH RD",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "141039678",
            "telephone_number": "585-721-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTICH",
        "first_name": "STACEY",
        "middle_name": "M",
        "credential": "OTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "006251-1",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Carpenter
• Minnie R Clark, NP
• Gary L Condoluci, LMT
• Anna C Copeland, RD
• William Clayton Cosman, M.D.
• Katie Crooks, L.M.T.
• Alexia Mariah Crutchfield, MS. ED., CCC-SLP
• Lillian Cultrara, OTR/L
• Dale Warren Sponaugle, MD, PC
• Vivian Ann Daly, CCC-SLP,NYS LIC.

• Occupational Therapy Assistant in Medina, NY
• Providers in Medina, NY by specialty
• Occupational Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; 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.