Provider Demographics
NPI:1194818443
Name:STEPAN, JANET (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:STEPAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:HASSOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:415 4TH ST. N. FARGO PUBLIC SCHOOLS
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-446-1269
Mailing Address - Fax:701-446-1200
Practice Address - Street 1:L 2120 9TH ST. S. LINCOLN ELEMENTARY SCHOOL
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-446-1269
Practice Address - Fax:701-446-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23655OtherBLUE CROSS/BLUE SHIELD
ND54628Medicaid
ND1452115Medicaid