Provider Demographics
NPI:1558482752
Name:DASHER, STEPHANIE JEAN (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:DASHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:WALDERZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:562 MCNEIL DR
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2515
Mailing Address - Country:US
Mailing Address - Phone:330-467-4156
Mailing Address - Fax:440-746-1732
Practice Address - Street 1:16761 SOUTHPARK CENTER
Practice Address - Street 2:SHOR - CLEVELAND CLINC, ST 30
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-878-3341
Practice Address - Fax:440-878-3020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-002702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer