Provider Demographics
NPI:1497521074
Name:PERSHEY, STEFFANY KATHLEEN
Entity Type:Individual
Prefix:
First Name:STEFFANY
Middle Name:KATHLEEN
Last Name:PERSHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N 129TH INFANTRY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8347
Mailing Address - Country:US
Mailing Address - Phone:815-729-2999
Mailing Address - Fax:
Practice Address - Street 1:823 N 129TH INFANTRY DR STE 104
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8347
Practice Address - Country:US
Practice Address - Phone:815-729-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist