Provider Demographics
NPI:1053160788
Name:DALY, STEPHANIE JO
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:DALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 DANIELLE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-0016
Mailing Address - Country:US
Mailing Address - Phone:219-682-5311
Mailing Address - Fax:
Practice Address - Street 1:1609 DANIELLE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-0016
Practice Address - Country:US
Practice Address - Phone:219-682-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist