Provider Demographics
NPI:1184780256
Name:PURYEAR, STEPHANIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W OKLAHOMA AVE STE 203
Mailing Address - Street 2:SENSORY STEPS INC. AT MARY PETERMAN MSW, LLC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-4303
Mailing Address - Country:US
Mailing Address - Phone:847-530-8943
Mailing Address - Fax:414-431-6401
Practice Address - Street 1:5757 W OKLAHOMA AVE STE 203
Practice Address - Street 2:SENSORY STEPS INC. AT MARY PETERMAN MSW, LLC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-4303
Practice Address - Country:US
Practice Address - Phone:847-530-8943
Practice Address - Fax:414-431-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005739225X00000X
WI555426225X00000X
CA12500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232059OtherBLUE CROSS BLUE SHIELD