Provider Demographics
NPI:1205321452
Name:PENKERT, STEPHANIE ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:PENKERT
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 1:1410 FOREST DR STE 29
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1446
Mailing Address - Country:US
Mailing Address - Phone:410-280-8774
Mailing Address - Fax:410-267-1995
Practice Address - Street 1:1410 FOREST DR STE 29
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1446
Practice Address - Country:US
Practice Address - Phone:410-280-8774
Practice Address - Fax:410-267-1995
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07015225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics