Provider Demographics
NPI:1700282209
Name:DOYLE, STEPHANIE MADONNA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MADONNA
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1931 BLACK ROCK TPKE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3506
Mailing Address - Country:US
Mailing Address - Phone:203-332-4363
Mailing Address - Fax:203-330-6761
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:SUITE 1 D
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4946
Practice Address - Country:US
Practice Address - Phone:203-378-0092
Practice Address - Fax:203-375-4540
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4343225XH1200X
CT004343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand