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NPI Code Detail

MEDICARE: STEPHANIE BLOMMEL OTR/L

MEDICARE: STEPHANIE BLOMMEL 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
1225X00000XOccupational Therapist5201007484MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15201007484OTHERMIOCCUPATIONAL THERAPY LICENSE

General Provider Information

NPI Number : 1598266173
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BLOMMEL OTR/L
Provider Business Mailing Address
First Line : 2563 BELL CIR
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-8700
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4368 CLEVELAND AVE
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9595
Country : US
Telephone Number : 269-983-6501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 06/11/2019

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