Provider Demographics
NPI:1003238080
Name:BINGHAM, STEPHANIE (ATC, OT-SC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:ATC, OT-SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 ADAMS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8625
Mailing Address - Country:US
Mailing Address - Phone:717-220-2020
Mailing Address - Fax:
Practice Address - Street 1:8125 ADAMS DR
Practice Address - Street 2:SUITE B
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8625
Practice Address - Country:US
Practice Address - Phone:717-220-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0060522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer