Provider Demographics
NPI:1710339056
Name:ROSE, STEPHANIE L (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:WOLEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14716-9755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048
Practice Address - Country:US
Practice Address - Phone:716-672-2000
Practice Address - Fax:716-363-2172
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031732255A2300X
NY31732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer