Provider Demographics
NPI:1699873059
Name:MARTIN, STEPHANIE ANNETTE (OTR)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 W HAINES PASS
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8461
Mailing Address - Country:US
Mailing Address - Phone:317-326-1917
Mailing Address - Fax:
Practice Address - Street 1:2031 W HAINES PASS
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-8461
Practice Address - Country:US
Practice Address - Phone:317-326-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000416A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist