Provider Demographics
NPI:1073766499
Name:BUSHNELL, STEPHANIE JO (CTRS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 SWAN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4807
Mailing Address - Country:US
Mailing Address - Phone:405-702-3242
Mailing Address - Fax:
Practice Address - Street 1:927 SWAN LAKE CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4807
Practice Address - Country:US
Practice Address - Phone:405-702-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist