Provider Demographics
NPI:1326306119
Name:SCHOENFELD, STEPHANIE SUE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUE
Last Name:SCHOENFELD
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 1:600 N ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4565
Mailing Address - Country:US
Mailing Address - Phone:208-489-4444
Mailing Address - Fax:
Practice Address - Street 1:5640 E FRANKLIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8402
Practice Address - Country:US
Practice Address - Phone:208-489-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1126224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDOTA-1126OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE