MEDICARE: STEPHANIE DENISE STEVENSON OT

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
1	225X00000X	Occupational Therapist	3265-026	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174696942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DENISE STEVENSON OT

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-0156
Country	:	US
Telephone Number	:	715-687-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 N SECOND AVENUE
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-0156
Country	:	US
Telephone Number	:	715-687-2214
Fax Number	:	715-687-4716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	11/15/2007

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