Healthcare Provider Details

I. General information

NPI: 1316304264
Provider Name (Legal Business Name): STEPHANIE CISLER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2016
Last Update Date: 01/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 FORSYTH ST
MACON GA
31201-2051
US

IV. Provider business mailing address

2490 RIVERSIDE DR STE B
MACON GA
31204-1787
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-2742
  • Fax:
Mailing address:
  • Phone: 478-633-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT006358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: