Provider Demographics
NPI:1700080751
Name:SCANZANO, STEPHANIE A (MSOTRL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SCANZANO
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 JENNINGS WAY
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1028
Mailing Address - Country:US
Mailing Address - Phone:856-430-7473
Mailing Address - Fax:
Practice Address - Street 1:545 BECKETT RD STE 106
Practice Address - Street 2:
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1507
Practice Address - Country:US
Practice Address - Phone:856-467-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00434100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist