Provider Demographics
NPI:1659667087
Name:STEVENSON, JOAN MARIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARIA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:MARIA
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:550 FOX STREET
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1418
Mailing Address - Country:US
Mailing Address - Phone:262-442-0435
Mailing Address - Fax:
Practice Address - Street 1:111 AKTINSON ST.
Practice Address - Street 2:UNIT 2
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149
Practice Address - Country:US
Practice Address - Phone:262-363-3268
Practice Address - Fax:262-363-3269
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1000-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist