Provider Demographics
NPI:1639433113
Name:GEURTS, STEPHANIE DOROTHY (OT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DOROTHY
Last Name:GEURTS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DOROTHY
Other - Last Name:HOSLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1630 COMMANCHE AVE
Mailing Address - Street 2:BELLIN SPORTS MEDICINE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-6089
Mailing Address - Country:US
Mailing Address - Phone:920-433-6700
Mailing Address - Fax:720-433-6709
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:BELLIN SPORTS MEDICINE
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6089
Practice Address - Country:US
Practice Address - Phone:920-433-6700
Practice Address - Fax:720-433-6709
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2934-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist