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NPI Code Detail

MEDICARE: BONNIE MARIE STEWART OTR

MEDICARE:   BONNIE MARIE STEWART  OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist4111-026WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093988610
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE MARIE STEWART OTR
Provider Business Mailing Address
First Line : 1193 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3054
Country : US
Telephone Number : 920-619-4072
Fax Number :
Provider Business Practice Location Address
First Line : 200 N 7TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1708
Country : US
Telephone Number : 920-743-6274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2008
Last Update Date : 04/03/2008

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Directions to “ BONNIE MARIE STEWART OTR” Practice Location

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