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General NPI Number Information
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NPI Number | 1942862073
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN WITT
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 2700 W HONADEL BLVD
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City | OAK CREEK
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State | WI
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Zip | 53154-2650
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Country | US
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Telephone | 414-435-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 7446 W BURDICK AVE
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City | MILWAUKEE
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State | WI
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Zip | 53219-3938
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Country | US
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Telephone | 920-323-7811
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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 | 5607-27
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License Number State | WI
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