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NPI Code Detail

MEDICARE: STEPHANIE WILMORE

MEDICARE: STEPHANIE WILMORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1114859261
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE WILMORE
Provider Business Mailing Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number : 260-497-0328
Fax Number :
Provider Business Practice Location Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number : 260-497-0328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ STEPHANIE WILMORE ” Practice Location

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