Healthcare Provider Details

I. General information

NPI: 1710023239
Provider Name (Legal Business Name): STEPHANIE LYNN KONSTANTINIDIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN GOODE OT

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-4298
  • Fax: 480-860-0356
Mailing address:
  • Phone: 480-860-4298
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3883
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: