Provider Demographics
NPI:1235597162
Name:HAUBNER, STEPHANIE EDEN CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EDEN CHRISTINE
Last Name:HAUBNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2004
Mailing Address - Country:US
Mailing Address - Phone:859-446-2419
Mailing Address - Fax:
Practice Address - Street 1:2074 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-2004
Practice Address - Country:US
Practice Address - Phone:859-446-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0047962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer