Healthcare Provider Details

I. General information

NPI: 1881508364
Provider Name (Legal Business Name): STEPHANIE SHOAF OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HIGHLAND AVE
MADISON WI
53792-0002
US

IV. Provider business mailing address

19432 SOUTHFIELD CT
TINLEY PARK IL
60487-5159
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.027110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: