Provider Demographics
NPI:1073876959
Name:CONLEY, STEFANIE (ATC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10663 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4403
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-792-3239
Practice Address - Street 1:10663 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4403
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-792-3239
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0037322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer