Provider Demographics
NPI:1720201254
Name:SENIOR, STEPHANIE E (OTRL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:SENIOR
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2511
Mailing Address - Country:US
Mailing Address - Phone:352-246-5384
Mailing Address - Fax:352-376-0126
Practice Address - Street 1:120 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2511
Practice Address - Country:US
Practice Address - Phone:352-246-5384
Practice Address - Fax:352-376-0126
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7345225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics