Individual
MRS. STEFANIE BREANNE WHALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/ T OT
Contact information
Practice address
1348 DIXON PKWY, CHESTERTON, IN 46304-9567
(219) 707-6511
Mailing address
1348 DIXON PKWY, CHESTERTON, IN 46304-9567
(219) 707-6511
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
32002593A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
927215735
PRIVATE INSURANCE
IN
Enumeration date
06/20/2019
Last updated
06/20/2019
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