Provider Demographics
NPI:1205243698
Name:WASHBURN, STEFANIE (MS, ATC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BAY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6900
Mailing Address - Country:US
Mailing Address - Phone:419-294-7522
Mailing Address - Fax:
Practice Address - Street 1:34 BAY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6900
Practice Address - Country:US
Practice Address - Phone:419-294-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer