Provider Demographics
NPI:1629349618
Name:SEVER, STEPHANIE ALLISON (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:SEVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX MXY 41B
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588
Mailing Address - Country:US
Mailing Address - Phone:907-554-1199
Mailing Address - Fax:
Practice Address - Street 1:6 OLD POTATO WAY
Practice Address - Street 2:
Practice Address - City:MCCARTHY
Practice Address - State:AK
Practice Address - Zip Code:99588
Practice Address - Country:US
Practice Address - Phone:907-554-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist