Provider Demographics
NPI:1629339288
Name:MOLTER, STEPHANIE PAIGE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:MOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BROOKHILL CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6044
Mailing Address - Country:US
Mailing Address - Phone:618-791-2045
Mailing Address - Fax:
Practice Address - Street 1:2 ANNABLE CT
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2204
Practice Address - Country:US
Practice Address - Phone:618-332-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology