Healthcare Provider Details

I. General information

NPI: 1942117577
Provider Name (Legal Business Name): MR. STEPHEN OSBORNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MCGHEE LN
WELLSTON OH
45692-9423
US

IV. Provider business mailing address

118 MCGHEE LN
WELLSTON OH
45692-9423
US

V. Phone/Fax

Practice location:
  • Phone: 740-710-6032
  • Fax:
Mailing address:
  • Phone: 740-710-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number05535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: