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General NPI Number Information
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NPI Number | 1770859357
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Entity Type | Individual
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Provider Name | STEPHANIE H CLINES PHD, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 09/29/2018
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Provider Practice Location Address
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Address Line | 5151 PARK AVE
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City | FAIRFIELD
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State | CT
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Zip | 06825-1090
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Country | US
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Telephone | 203-365-4475
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 PARK AVE
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City | FAIRFIELD
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State | CT
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Zip | 06825-1090
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Country | US
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Telephone | 203-365-4475
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2011016897
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002493
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000815
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License Number State | CT
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