Provider Demographics
NPI:1558233197
Name:FAULKNER, STEPHANIE REJEANA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REJEANA
Last Name:FAULKNER
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 1:214 BROOKS LN
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2128
Mailing Address - Country:US
Mailing Address - Phone:443-525-8134
Mailing Address - Fax:
Practice Address - Street 1:1110 S TALBOT ST STE 6
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2606
Practice Address - Country:US
Practice Address - Phone:443-695-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist