Provider Demographics
NPI:1578039186
Name:FALES, STEPHANIE SHAY (OTRL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHAY
Last Name:FALES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:STEPPHANIE
Other - Middle Name:SHAY
Other - Last Name:GILDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3065 ZETTEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9634
Mailing Address - Country:US
Mailing Address - Phone:989-312-1414
Mailing Address - Fax:
Practice Address - Street 1:335 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1127
Practice Address - Country:US
Practice Address - Phone:989-343-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist