Provider Demographics
NPI:1396150314
Name:HARRY, STEPHANIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:HARRY
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 1:7055 MEXICO RD UNIT 1601
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2344
Mailing Address - Country:US
Mailing Address - Phone:636-866-1341
Mailing Address - Fax:636-323-2155
Practice Address - Street 1:7055 MEXICO RD UNIT 1601
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2344
Practice Address - Country:US
Practice Address - Phone:636-866-1341
Practice Address - Fax:636-323-2155
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist