Healthcare Provider Details

I. General information

NPI: 1093677668
Provider Name (Legal Business Name): STEPHANIE FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 SAWGRASS LAKE CT
NOKOMIS FL
34275-4366
US

IV. Provider business mailing address

6063 SAWGRASS LAKE CT
NOKOMIS FL
34275-4366
US

V. Phone/Fax

Practice location:
  • Phone: 617-799-2014
  • Fax:
Mailing address:
  • Phone: 617-799-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT24399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: