Healthcare Provider Details

I. General information

NPI: 1366413965
Provider Name (Legal Business Name): STEPHANIE B GIFFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE S BALDWIN

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 W GRAND RIVER AVE STE 600
BRIGHTON MI
48116-4359
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-1187
  • Fax: 810-225-1284
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3909-026
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: