Provider Demographics
NPI:1760517379
Name:DUSTMAN, STEPHANIE A (MS OTR)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:DUSTMAN
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N TWYMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-3200
Mailing Address - Country:US
Mailing Address - Phone:816-796-8762
Mailing Address - Fax:816-796-3657
Practice Address - Street 1:FORT OSAGE R-I SCHOOL DISTRICT
Practice Address - Street 2:2101 N TWYMAN RD
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3200
Practice Address - Country:US
Practice Address - Phone:816-796-8762
Practice Address - Fax:816-796-3657
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO476681937Medicaid