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General NPI Number Information
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NPI Number | 1649454174
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Entity Type | Individual
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Provider Name | JOANN LORAE STANGER OTR
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 681 BEVILLE RD
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-1951
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Country | US
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Telephone | 800-330-7711
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Fax | 866-426-2811
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | CALDWELL
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State | TX
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Zip | 77836-0853
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Country | US
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Telephone | 512-745-0121
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | AA423970
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License Number State | MD
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