Individual
MS. STEPHANIE MARIE PROROK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
287 CHESTNUT W, RANDOLPH, MA 02368-2371
(555) 555-5555
Mailing address
287 CHESTNUT W, RANDOLPH, MA 02368-2371
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8262
MA
Other
Enumeration date
08/01/2008
Last updated
06/22/2021
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