Provider Demographics
NPI:1316522642
Name:GRANT, STEPHANIE MARIA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIA
Last Name:GRANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 DESERT SPRING CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-907-4914
Mailing Address - Fax:
Practice Address - Street 1:7405 DESERT SPRING CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-907-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2025-03-11
Deactivation Date:2024-03-04
Deactivation Code:
Reactivation Date:2025-02-25
Provider Licenses
StateLicense IDTaxonomies
OH33.026154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist