Individual
MRS. STEPHANIE LYNN DE SAM LAZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
900 W 94TH STREET, THE THERAPY PLACE, BLOOMINGTON, MN 55420
(952) 885-0418
Mailing address
1925 MONTREAL AVE, SAINT PAUL, MN 55116
(651) 699-5296
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103343
MN
Other
Enumeration date
10/20/2006
Last updated
07/08/2007
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