Provider Demographics
NPI:1689854689
Name:EWONIUK, STEPHANIE JANE HARRIS (MOT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANE HARRIS
Last Name:EWONIUK
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JANE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-0932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 W BLAIR AVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-7113
Practice Address - Country:US
Practice Address - Phone:307-352-3626
Practice Address - Fax:307-352-3628
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist