Provider Demographics
NPI:1093978579
Name:PAVESE, STEPHANIE LYNN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:PAVESE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-3412
Mailing Address - Country:US
Mailing Address - Phone:973-426-1046
Mailing Address - Fax:
Practice Address - Street 1:143 LANDING RD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1507
Practice Address - Country:US
Practice Address - Phone:973-770-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00276100172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker