Provider Demographics
NPI:1114112653
Name:MENENDEZ, STEPHANIE DENISE (OTR)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DENISE
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:DENISE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:15955 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1227
Mailing Address - Country:US
Mailing Address - Phone:314-953-5000
Mailing Address - Fax:
Practice Address - Street 1:15875 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1225
Practice Address - Country:US
Practice Address - Phone:314-953-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist