Provider Demographics
NPI:1275608705
Name:TOLLAN, STEPHANIE A (OTR L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:TOLLAN
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-428-8292
Mailing Address - Fax:
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-428-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA169249OtherLABOR AND INDUSTRIES
WA5871TOOtherREGENCE BCBS TACOMA
WA7472TOOtherREGENCE BCBS GIG HARBOR
WA8369340Medicaid
WA8369340Medicaid