Provider Demographics
NPI:1912384272
Name:MAZEROLLE, STEPHANIE (PHD, ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAZEROLLE
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1034
Mailing Address - Country:US
Mailing Address - Phone:860-608-4184
Mailing Address - Fax:
Practice Address - Street 1:2095 HILLSIDE RD
Practice Address - Street 2:UNIT 1110 DEPARTMENT OF KINESIOLOGY
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1110
Practice Address - Country:US
Practice Address - Phone:860-486-4536
Practice Address - Fax:860-486-1123
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer