Provider Demographics
NPI:1265769103
Name:MCCARTHY, STEPHANIE (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCCARTHY
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:N26W23977 WATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1006
Mailing Address - Country:US
Mailing Address - Phone:262-523-9093
Mailing Address - Fax:
Practice Address - Street 1:N26W23977 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1006
Practice Address - Country:US
Practice Address - Phone:262-523-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI324226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI225X00000XMedicaid