Provider Demographics
NPI:1184082323
Name:BRAUN, STEPHANIE (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 ASHCROFT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-9337
Mailing Address - Country:US
Mailing Address - Phone:317-313-0287
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FWY
Practice Address - Street 2:SUITE 602
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4545
Practice Address - Country:US
Practice Address - Phone:214-306-9805
Practice Address - Fax:877-788-7505
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005366A225X00000X
IN10049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist