Provider Demographics
NPI:1225066814
Name:DOSTER, STEPHANIE W (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:W
Last Name:DOSTER
Suffix:
Gender:F
Credentials: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:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-0531
Mailing Address - Country:US
Mailing Address - Phone:406-212-3908
Mailing Address - Fax:
Practice Address - Street 1:250 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2157
Practice Address - Country:US
Practice Address - Phone:406-212-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400476Medicaid
MT662030OtherBCBS
MT000050712Medicare ID - Type Unspecified