Provider Demographics
NPI:1518261866
Name:REISENBUCHLER, STEPHANIE ROBERTA (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROBERTA
Last Name:REISENBUCHLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S BOTHWELL ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6119
Mailing Address - Country:US
Mailing Address - Phone:847-902-9344
Mailing Address - Fax:
Practice Address - Street 1:121 S BOTHWELL ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6119
Practice Address - Country:US
Practice Address - Phone:847-902-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001258224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant