Provider Demographics
NPI:1386159085
Name:PIACENTE, STEPHANIE RENEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:PIACENTE
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 1:68 SNOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ZION GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17985-9305
Mailing Address - Country:US
Mailing Address - Phone:570-985-6086
Mailing Address - Fax:
Practice Address - Street 1:750 REAR STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:SYBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18251
Practice Address - Country:US
Practice Address - Phone:570-708-2525
Practice Address - Fax:570-788-5722
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist