Healthcare Provider Details

I. General information

NPI: 1841634839
Provider Name (Legal Business Name): STEPHANIE PATIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 FIFIELD RD
PELLA IA
50219-7925
US

IV. Provider business mailing address

2319 N 7TH AVE E
NEWTON IA
50208-2663
US

V. Phone/Fax

Practice location:
  • Phone: 641-458-6411
  • Fax:
Mailing address:
  • Phone: 925-642-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: