Provider Demographics
NPI:1063754539
Name:STEGLE, KATHLEEN ELIZABETH
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:STEGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 INDUSTRIAL DR
Mailing Address - Street 2:APT 4B
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-2162
Mailing Address - Country:US
Mailing Address - Phone:618-697-5649
Mailing Address - Fax:
Practice Address - Street 1:101 INDUSTRIAL DR
Practice Address - Street 2:APT 4B
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2162
Practice Address - Country:US
Practice Address - Phone:618-697-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist