Provider Demographics
NPI:1790815603
Name:LOHMAR, STEPHANIE L (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:LOHMAR
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 1:110 VIRGIL ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2637
Mailing Address - Country:US
Mailing Address - Phone:636-272-1059
Mailing Address - Fax:636-980-1946
Practice Address - Street 1:110 VIRGIL ST
Practice Address - Street 2:FT ZUMWALT R-II
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2637
Practice Address - Country:US
Practice Address - Phone:636-272-1059
Practice Address - Fax:636-980-1946
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475918009Medicaid