Provider Demographics
NPI:1861382749
Name:ORIGIN STORY LLC
Entity type:Organization
Organization Name:ORIGIN STORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED LACTATION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:CLC
Authorized Official - Phone:541-261-3537
Mailing Address - Street 1:1075 SMALLWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-3124
Mailing Address - Country:US
Mailing Address - Phone:541-261-3537
Mailing Address - Fax:
Practice Address - Street 1:1075 SMALLWOOD TRL
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-3124
Practice Address - Country:US
Practice Address - Phone:541-261-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care