Provider Demographics
NPI:1770231995
Name:NEAL, STEPHANIE DEANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEANNA
Last Name:NEAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DEANNA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:296 LANG HILL RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:ME
Mailing Address - Zip Code:04965-3607
Mailing Address - Country:US
Mailing Address - Phone:207-416-6196
Mailing Address - Fax:
Practice Address - Street 1:335 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3993
Practice Address - Country:US
Practice Address - Phone:207-947-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist