Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 5853 | OH |
NPI | 1003389271 |
---|---|
Provider Name | Stephanie Marie Corlew |
First Address | Ashtabula, OH 44004-2545 |
Second Address | Ashtabula, OH 44004-3262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 09/01/2019 |