MEDICARE: STEPHANIE HENNARD CTRS

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	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1699010462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HENNARD CTRS

Provider Business Mailing Address
First Line	:	40002 EAGLE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1920
Country	:	US
Telephone Number	:	586-604-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	40002 EAGLE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1920
Country	:	US
Telephone Number	:	586-604-6323
Fax Number	:

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

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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Directions to “ STEPHANIE HENNARD CTRS” Practice Location

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