Provider Demographics
NPI:1427037498
Name:STEFAN, MARJORIE ELLEN (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ELLEN
Last Name:STEFAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MARJORIE
Other - Middle Name:ELLEN
Other - Last Name:STEFAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:CMR 446, BOX 15
Mailing Address - Street 2:UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 446, BOX 15
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:49931-804-3503
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004201A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist