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General NPI Number Information
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NPI Number | 1295337590
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Entity Type | Individual
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Provider Name | STEPHANIE ELIZABETH MATILE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 807 W JEFFERSON ST UNIT U
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City | SHOREWOOD
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State | IL
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Zip | 60404-7301
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Country | US
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Telephone | 815-714-2977
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 FACEL VEGA DR
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City | JOLIET
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State | IL
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Zip | 60435-6487
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Country | US
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Telephone | 815-557-7787
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.013444
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License Number State | IL
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