Provider Demographics
NPI:1427229004
Name:SCRUGGS, STEPHANIE (LICDC-CS, LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:LICDC-CS, LMT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:NELMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC-CS, LMT
Mailing Address - Street 1:3021 VERNON PLACE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2417
Mailing Address - Country:US
Mailing Address - Phone:513-541-7099
Mailing Address - Fax:513-541-0989
Practice Address - Street 1:630 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2422
Practice Address - Country:US
Practice Address - Phone:859-491-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist