Provider Demographics
NPI:1366757643
Name:CASTRO, STEPHANIE L (OTR)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 TINCHER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-3780
Mailing Address - Country:US
Mailing Address - Phone:317-856-4851
Mailing Address - Fax:317-856-3391
Practice Address - Street 1:4870 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4432
Practice Address - Country:US
Practice Address - Phone:765-254-9717
Practice Address - Fax:765-254-9739
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005000QA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist