Provider Demographics
NPI:1912324690
Name:PHILLIPS, STEPHANIE KAY (LMT, MMP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 WESTWYCK DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9616
Mailing Address - Country:US
Mailing Address - Phone:419-346-7923
Mailing Address - Fax:
Practice Address - Street 1:6975 WESTWYCK DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9616
Practice Address - Country:US
Practice Address - Phone:419-346-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist