Basic Information
| Provider Information | |||||||||
| NPI: | 1730566761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YINGLING | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MOT,OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 W NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623531208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172427037 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 CAMDEN RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623531058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177733377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 04/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.010903 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.