Provider Demographics
NPI:1962793158
Name:KRAEMER, STEPHANIE LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:635 S WICKHAM RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1436
Mailing Address - Country:US
Mailing Address - Phone:321-723-1011
Mailing Address - Fax:321-723-1110
Practice Address - Street 1:635 S WICKHAM RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1436
Practice Address - Country:US
Practice Address - Phone:321-723-1011
Practice Address - Fax:321-723-1110
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA31190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist