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General NPI Number Information
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NPI Number | 1417089434
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Entity Type | Individual
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Provider Name | STEPHANIE BETH SARE
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 650 N EAST ST
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City | SPENCER
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State | IN
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Zip | 47460-1007
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Country | US
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Telephone | 812-829-2459
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Fax | 812-828-0884
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Provider Business Mailing Address
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Address Line | 650 N EAST ST
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City | SPENCER
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State | IN
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Zip | 47460-1007
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Country | US
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Telephone | 812-829-2459
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Fax | 812-828-0884
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 750771
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License Number State | IN
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