MEDICARE: MS. STEPHANIE NEAL

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	119593	TX
2	225XP0019X	Physical Rehabilitation Occupational Therapist
3	225X00000X	Occupational Therapist	07890	MD

General Provider Information

NPI Number	:	1295230712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE NEAL

Provider Business Mailing Address
First Line	:	11964 AUTUMNWOOD LN
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11964 AUTUMNWOOD LN
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6057
Country	:	US
Telephone Number	:	301-801-0489
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	01/23/2019

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