Basic Information
| Provider Information | |||||||||
| NPI: | 1649454174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANGER | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | LORAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 853 | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778360853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127450121 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 681 BEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321191951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003307711 | ||||||||
| FaxNumber: | 8664262811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2007 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XN1300X | AA423970 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No ID Information.