Individual
STEPHEN JAE NISEWANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
735 S 2ND ST, CRESWELL, OR 97426-7507
(541) 895-3333
Mailing address
791 THRONE DR APT 304, EUGENE, OR 97402-7752
(541) 206-4707
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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