Provider Demographics
NPI:1841919503
Name:D'AUTEUIL, STEFAN
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:D'AUTEUIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16675 MASTEN MILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739
Mailing Address - Country:US
Mailing Address - Phone:808-280-1776
Mailing Address - Fax:
Practice Address - Street 1:57031 PONDEROSA ROAD
Practice Address - Street 2:BLD 27 STE M2
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:808-280-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist