Provider Demographics
NPI:1841822939
Name:FITZGERALD, STEPHANIE L (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FITZGERALD
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 1:76 ACCORD PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1606
Mailing Address - Country:US
Mailing Address - Phone:781-923-0900
Mailing Address - Fax:781-616-3306
Practice Address - Street 1:76 ACCORD PARK DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1606
Practice Address - Country:US
Practice Address - Phone:781-923-0900
Practice Address - Fax:781-616-3306
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12934225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist