Provider Demographics
NPI:1821427378
Name:LANCASTER, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MADISON
Mailing Address - Street 2:SUITE EC013
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2243
Mailing Address - Country:US
Mailing Address - Phone:901-448-6438
Mailing Address - Fax:901-448-1411
Practice Address - Street 1:930 MADISON
Practice Address - Street 2:SUITE EC013
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2243
Practice Address - Country:US
Practice Address - Phone:901-448-6438
Practice Address - Fax:901-448-1411
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446645Medicaid
TN3133295OtherBLUE CROSS BLUE SHIELD
TN0446645Medicaid