Provider Demographics
NPI:1609097609
Name:STEGENGA, JUDY A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:STEGENGA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:USTASIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 THE GREENWAY
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1107
Mailing Address - Country:US
Mailing Address - Phone:978-744-7037
Mailing Address - Fax:
Practice Address - Street 1:103 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4001
Practice Address - Country:US
Practice Address - Phone:781-593-2727
Practice Address - Fax:781-593-2542
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist