Provider Demographics
NPI:1043549264
Name:STEPHAN, CHRISTINE MICHELE (MA,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3515
Mailing Address - Country:US
Mailing Address - Phone:253-318-4118
Mailing Address - Fax:
Practice Address - Street 1:25 RAFT ISLAND DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5918
Practice Address - Country:US
Practice Address - Phone:253-318-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist