Provider Demographics
NPI:1891068375
Name:KERWIN, STEPHANIE ANN
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:KERWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 BOSTON POST RD E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3527
Mailing Address - Country:US
Mailing Address - Phone:508-624-0304
Mailing Address - Fax:508-624-0391
Practice Address - Street 1:221 BOSTON POST RD E
Practice Address - Street 2:SUITE 150
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3527
Practice Address - Country:US
Practice Address - Phone:508-624-0304
Practice Address - Fax:508-624-0391
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist