Healthcare Provider Details

I. General information

NPI: 1649454174
Provider Name (Legal Business Name): JOANN LORAE STANGER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 BEVILLE RD
SOUTH DAYTONA FL
32119-1951
US

IV. Provider business mailing address

PO BOX 853
CALDWELL TX
77836-0853
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax: 866-426-2811
Mailing address:
  • Phone: 512-745-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberAA423970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: