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General NPI Number Information
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NPI Number | 1386158210
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Entity Type | Individual
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Provider Name | STEPHANIE S. REBENOCK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 245 SYCAMORE ST
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City | SAUK CITY
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State | WI
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Zip | 53583-1013
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Country | US
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Telephone | 608-643-3383
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Fax |
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Provider Business Mailing Address
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Address Line | 4604 N LAURA DR
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City | JANESVILLE
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State | WI
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Zip | 53548-8690
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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