Provider Demographics
NPI:1891305363
Name:LEMBACH-WITMER, STEPHANIE LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:LEMBACH-WITMER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:LEMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11378 AUTUMN BREEZE TRL
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1592
Mailing Address - Country:US
Mailing Address - Phone:810-516-1022
Mailing Address - Fax:
Practice Address - Street 1:11378 AUTUMN BREEZE TRL
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1592
Practice Address - Country:US
Practice Address - Phone:810-516-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007686224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant