Provider Demographics
NPI:1184199416
Name:CHERUBIN, STEPHANIE LAURENCE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAURENCE
Last Name:CHERUBIN
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 1:3024 HIDDEN FOREST CT UNIT 6314
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3160
Mailing Address - Country:US
Mailing Address - Phone:862-888-2806
Mailing Address - Fax:678-461-9804
Practice Address - Street 1:3024 HIDDEN FOREST CT UNIT 6314
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3160
Practice Address - Country:US
Practice Address - Phone:862-888-2806
Practice Address - Fax:678-461-9804
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007583225X00000X
NY022657225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics