MEDICARE: STEPHANIE LYNN ANDERSON MSOTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	10-0068	NV

General Provider Information

NPI Number	:	1891096772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN ANDERSON MSOTR

Provider Business Mailing Address
First Line	:	1904 AUTUMN SAGE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1698
Country	:	US
Telephone Number	:	702-401-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 AUTUMN SAGE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1698
Country	:	US
Telephone Number	:	702-401-1994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	01/10/2022

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