Provider Demographics
NPI:1073861241
Name:BEDAW, STEPHANIE LEE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LEE
Last Name:BEDAW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1301
Mailing Address - Country:US
Mailing Address - Phone:603-831-1877
Mailing Address - Fax:
Practice Address - Street 1:106 PERIMETER RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1301
Practice Address - Country:US
Practice Address - Phone:603-831-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3772M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist