Provider Demographics
NPI:1366777476
Name:STALNAKER, NICOLE MANOLESCU (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MANOLESCU
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:SHAWNA
Other - Last Name:MANOLESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1614
Mailing Address - Country:US
Mailing Address - Phone:315-368-4072
Mailing Address - Fax:
Practice Address - Street 1:4279 CRESTED BUTTE RUN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-1355
Practice Address - Country:US
Practice Address - Phone:315-569-9308
Practice Address - Fax:315-295-2579
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation