Provider Demographics
NPI:1801074901
Name:OAKES, STEPHANIE KAE (MPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAE
Last Name:OAKES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 LAKE DR SE STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1674
Mailing Address - Country:US
Mailing Address - Phone:616-248-9842
Mailing Address - Fax:616-248-9848
Practice Address - Street 1:1331 LAKE DR SE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1674
Practice Address - Country:US
Practice Address - Phone:616-248-9842
Practice Address - Fax:616-248-9848
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist