Provider Demographics
NPI:1558642348
Name:LAKOWSKI, STEPHANIE LOUISE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:LAKOWSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2401 SMIZER MILL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2283
Mailing Address - Country:US
Mailing Address - Phone:636-225-1760
Mailing Address - Fax:
Practice Address - Street 1:3488 JEFFCO BLVD
Practice Address - Street 2:SUITE 103A
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6015
Practice Address - Country:US
Practice Address - Phone:636-464-5439
Practice Address - Fax:636-464-5438
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033757224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant