Provider Demographics
NPI:1194480343
Name:STEPHEN, JEANNETTE ELIZABETH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:ELIZABETH
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 ROUTE 16
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:NY
Mailing Address - Zip Code:14101-9771
Mailing Address - Country:US
Mailing Address - Phone:163-353-8516
Mailing Address - Fax:
Practice Address - Street 1:9822 ROUTE 16
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:NY
Practice Address - Zip Code:14101-9771
Practice Address - Country:US
Practice Address - Phone:716-353-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017903-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist