MEDICARE: MRS. STEPHANIE PURYEAR OTR/L

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
1	225X00000X	Occupational Therapist	056-005739	IL
2	225X00000X	Occupational Therapist	555426	WI
3	225X00000X	Occupational Therapist	12500	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02232059	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1184780256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE PURYEAR OTR/L

Provider Business Mailing Address
First Line	:	5757 W OKLAHOMA AVE STE 203
Second Line	:	SENSORY STEPS INC. AT MARY PETERMAN MSW, LLC
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-4303
Country	:	US
Telephone Number	:	847-530-8943
Fax Number	:	414-431-6401

Provider Business Practice Location Address
First Line	:	5757 W OKLAHOMA AVE STE 203
Second Line	:	SENSORY STEPS INC. AT MARY PETERMAN MSW, LLC
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-4303
Country	:	US
Telephone Number	:	847-530-8943
Fax Number	:	414-431-6401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	12/02/2014

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