Provider Demographics
NPI:1699911933
Name:POGONOWSKI, STEPHANIE (OT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:POGONOWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2843
Mailing Address - Country:US
Mailing Address - Phone:301-515-0900
Mailing Address - Fax:240-912-2381
Practice Address - Street 1:6710A ROCKLEDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2843
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:240-912-2381
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010001003225X00000X
VA0119005857225X00000X
MD08109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK949-0066OtherCARE FIRST