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General NPI Number Information
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NPI Number | 1184199416
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Entity Type | Individual
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Provider Name | STEPHANIE LAURENCE CHERUBIN M.S., OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 3024 HIDDEN FOREST CT UNIT 6314
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City | MARIETTA
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State | GA
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Zip | 30066-3160
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Country | US
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Telephone | 862-888-2806
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Fax | 678-461-9804
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Provider Business Mailing Address
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Address Line | 3024 HIDDEN FOREST CT UNIT 6314
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City | MARIETTA
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State | GA
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Zip | 30066-3160
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Country | US
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Telephone | 862-888-2806
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Fax | 678-461-9804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT007583
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 022657
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 022657
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License Number State | NY
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