Provider Demographics
NPI:1386850675
Name:OETJEN, STEPHANIE P (MPT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:P
Last Name:OETJEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 KENNEDY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213
Mailing Address - Country:US
Mailing Address - Phone:513-618-7878
Mailing Address - Fax:513-618-7888
Practice Address - Street 1:5400 KENNEDY AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213
Practice Address - Country:US
Practice Address - Phone:513-618-7878
Practice Address - Fax:513-618-7888
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OE409245Medicare ID - Type Unspecified