Provider Demographics
NPI:1104942796
Name:ELHART, STEPHANIE NICOLE (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:ELHART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:N
Other - Last Name:POLENCHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 LELARAY ST
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-475-0477
Mailing Address - Fax:719-475-1021
Practice Address - Street 1:2210 LELARAY ST
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-475-0477
Practice Address - Fax:719-475-1021
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1051188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34555251Medicaid