Provider Demographics
NPI:1316546526
Name:KLABOE-STEPHENS, EMMA LORN (COTA/L)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LORN
Last Name:KLABOE-STEPHENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N 12TH AVE APT 221
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2451
Mailing Address - Country:US
Mailing Address - Phone:715-292-7147
Mailing Address - Fax:
Practice Address - Street 1:1425 N 12TH AVE APT 221
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2451
Practice Address - Country:US
Practice Address - Phone:715-292-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5727224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant