Healthcare Provider Details

I. General information

NPI: 1174741763
Provider Name (Legal Business Name): LINDA STEFANICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 LAKESIDE CIR
POMPANO BEACH FL
33060-7748
US

IV. Provider business mailing address

1240 SE 6TH TER
POMPANO BEACH FL
33060-9411
US

V. Phone/Fax

Practice location:
  • Phone: 954-783-4005
  • Fax:
Mailing address:
  • Phone: 508-341-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT 12853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: