Provider Demographics
NPI:1407407422
Name:IRVINE, STEPHANIE (OT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6346 FEATHER RUN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8653
Mailing Address - Country:US
Mailing Address - Phone:812-614-4394
Mailing Address - Fax:
Practice Address - Street 1:6346 FEATHER RUN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8653
Practice Address - Country:US
Practice Address - Phone:812-614-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004934A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist