MEDICARE: MRS. STEPHENIE KATHRYN SETA

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1588874705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHENIE KATHRYN SETA

Provider Business Mailing Address
First Line	:	515 S GRAND AVE
Second Line	:	APARTMENT 2
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2122
Country	:	US
Telephone Number	:	859-250-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	4552 PATRON CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5808
Country	:	US
Telephone Number	:	513-661-6764
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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