Provider Demographics
NPI:1255155578
Name:VAN SLYKE, STEPHANIE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:VAN SLYKE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5606
Mailing Address - Country:US
Mailing Address - Phone:815-278-2515
Mailing Address - Fax:
Practice Address - Street 1:9783 E 116TH ST # 245
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-2822
Practice Address - Country:US
Practice Address - Phone:815-278-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006739A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics