Provider Demographics
NPI:1962247262
Name:KLOTZ, STEPHANIE THAIS (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:THAIS
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N 23RD ST APT 324
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1671
Mailing Address - Country:US
Mailing Address - Phone:610-392-7213
Mailing Address - Fax:
Practice Address - Street 1:139 N 23RD ST APT 324
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1671
Practice Address - Country:US
Practice Address - Phone:610-392-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist