Provider Demographics
NPI:1659917235
Name:JEAN-MICHEL, STEPHANIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:JEAN-MICHEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-3248
Mailing Address - Country:US
Mailing Address - Phone:857-891-0189
Mailing Address - Fax:
Practice Address - Street 1:126 WARWICK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-3248
Practice Address - Country:US
Practice Address - Phone:857-891-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA430701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist