Provider Demographics
NPI:1174795967
Name:SLIWA, STEPHANIE JOHNSON (OTR/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOHNSON
Last Name:SLIWA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:484-678-2378
Mailing Address - Fax:
Practice Address - Street 1:26089 SHOPPES AT LONG NECK BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-947-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010673225X00000X
DEU1-0001870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist