Provider Demographics
NPI:1316568496
Name:SEBALD, STEPHANIE (OTRL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SEBALD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:PIECHOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:3106 VALORIE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 1000
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-871-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty