Stephanie A Kenneally, MOT, OTR/L
Individual provider Active NPI Contractor · Freehold, NJ
NPI 1104101617 · NPPES record last updated Apr 9, 2019
Key facts
- NPI
- 1104101617
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 46TR0542000 (NJ)
- Practice address
- 40 Canterbury Dr
Freehold, NJ 07728-4421 - Phone
- (732) 266-8814
- NPI assigned
- Oct 15, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Apex Home Therapy LLC
Practice addresses (Care Compare)
40 Canterbury Dr
Freehold, NJ 07728-4421
Phone (201) 658-5056
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111208000135 | NJ | Practitioner - Occupational Therapist in Private Practice | 2163697871 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46TR0542000 | NJ | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apex Home Therapy LLC | Current |
Accepting new patients | |
| At Home by Enhance Therapies LLC | Current |
Accepting new patients | |
| Home Sweet Home Therapy LLC | Past |
Accepting new patients |
Locations
411 Hackensack Ave
Ste 200
Hackensack, NJ 07601
Phone (732) 987-3833
400 Route 70
Lakewood, NJ 08701
Phone (732) 802-7512
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 46TR0542000 | NJ | Yes |
Addresses
Primary practice location
40 Canterbury Dr
Freehold, NJ 07728-4421
Mailing address
257B Matchaponix Ave
Monroe, NJ 08831-4034
Phone (732) 266-8814
Other practice location 1
38 Hillwood Rd
East Brunswick, NJ 08816-4622
Phone (732) 266-8814
Other names
- Stephanie A Blanar
Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.