Provider Demographics
NPI:1164189601
Name:SHEYNERMAN, STEPHANIE C (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:SHEYNERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:122 W TRINITY PL APT 1606
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3678
Mailing Address - Country:US
Mailing Address - Phone:917-704-3688
Mailing Address - Fax:
Practice Address - Street 1:1514 CLEVELAND AVE STE 101-B
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6965
Practice Address - Country:US
Practice Address - Phone:678-322-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics