MEDICARE: STEPHANIE WELLMAN 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	225XP0200X	Pediatric Occupational Therapist	6486	AZ

General Provider Information

NPI Number	:	1528428836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WELLMAN OTR/L

Provider Business Mailing Address
First Line	:	5350 E TAYLOR ST
Second Line	:	APT 132
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 E TAYLOR ST
Second Line	:	APT 132
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6746
Country	:	US
Telephone Number	:	260-251-9087
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	02/29/2016

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