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General NPI Number Information
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NPI Number | 1326308446
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Entity Type | Individual
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Provider Name | STEPHANIE RAE NIEDZIELSKI OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR MCHE-QD (CREDS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-808-2237
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Fax |
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Provider Business Mailing Address
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Address Line | 7461 KITTY HAWK APT 9208
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City | CONVERSE
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State | TX
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Zip | 78109-1670
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Country | US
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Telephone | 989-316-6165
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201008186
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License Number State | MI
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