Healthcare Provider Details

I. General information

NPI: 1700172699
Provider Name (Legal Business Name): STEPHANIE MICHELLE HOVER O.T.R./L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SCHOOL STREET
BERLIN NY
12022
US

IV. Provider business mailing address

P.O. BOX 216
STEPHENTOWN NY
12168
US

V. Phone/Fax

Practice location:
  • Phone: 518-658-2107
  • Fax:
Mailing address:
  • Phone: 518-733-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004887-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: