Provider Demographics
NPI:1417450933
Name:STANTON, STEPHANIE (OTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 S LAKE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1243
Mailing Address - Country:US
Mailing Address - Phone:810-714-2884
Mailing Address - Fax:
Practice Address - Street 1:1179 S LAKE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1243
Practice Address - Country:US
Practice Address - Phone:810-714-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-11
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist