Provider Demographics
NPI:1053902338
Name:MURPHY, STEPHANIE REBECCA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REBECCA
Last Name:MURPHY
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 1:2519 S SHIELDS ST
Mailing Address - Street 2:STE 1-K #118
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1855
Mailing Address - Country:US
Mailing Address - Phone:719-270-1322
Mailing Address - Fax:
Practice Address - Street 1:2519 S SHIELDS ST
Practice Address - Street 2:STE 1-K #118
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1855
Practice Address - Country:US
Practice Address - Phone:719-270-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist