Provider Demographics
NPI:1942525589
Name:LEMELLE, STEPHANIE LATRICE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LATRICE
Last Name:LEMELLE
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 1:4728 WINDERMERE CT
Mailing Address - Street 2:APT 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6345
Mailing Address - Country:US
Mailing Address - Phone:757-965-3382
Mailing Address - Fax:
Practice Address - Street 1:4728 WINDERMERE CT
Practice Address - Street 2:APT 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6345
Practice Address - Country:US
Practice Address - Phone:757-965-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000125224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant