Provider Demographics
NPI:1043763105
Name:OELLIEN, STEPHANIE (ATC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:OELLIEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 RANCHO VIEJO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1557
Mailing Address - Country:US
Mailing Address - Phone:505-231-1616
Mailing Address - Fax:
Practice Address - Street 1:POJOAQUE VALLEY HIGH SCHOOL
Practice Address - Street 2:1575 STATE ROAD 502 WEST
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-455-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAT7502255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer