MEDICARE: MRS. STEPHANIE J TEODOSIO OTR L

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	1002046	OH
2	225X00000X	Occupational Therapist	003544	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003544	OTHER	OH	OHIO OT PT ATC BOARD

General Provider Information

NPI Number	:	1720078306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE J TEODOSIO OTR L

Provider Business Mailing Address
First Line	:	533 E MAIN ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3218
Country	:	US
Telephone Number	:	330-297-9020
Fax Number	:	330-297-9095

Provider Business Practice Location Address
First Line	:	6847 N CHESTNUT ST
Second Line	:	SUITE 100
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-297-2770
Fax Number	:	330-297-8833

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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