Individual
STEPHANIE GLORIA DEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 OKEEFFE AVE APT 113, SUN PRAIRIE, WI 53590-4229
(612) 309-2062
Mailing address
1330 OKEEFFE AVE APT 113, SUN PRAIRIE, WI 53590-4229
(612) 309-2062
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6721-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
435982
NBCOT
—
01
—
6721-26
STATE OF WISCONSIN
WI
Enumeration date
07/29/2020
Last updated
07/29/2020
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