Healthcare Provider Details

I. General information

NPI: 1215123351
Provider Name (Legal Business Name): JUDITH LYNN STEVENSON L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 SAWMILL RD
COLUMBUS OH
43220-2247
US

IV. Provider business mailing address

6085 LONDON GROVEPORT RD
GROVE CITY OH
43123-8947
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-0983
  • Fax:
Mailing address:
  • Phone: 614-286-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number33.015954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: