Healthcare Provider Details

I. General information

NPI: 1588389043
Provider Name (Legal Business Name): STEPHANIE ANN ADAMS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ROY WALL BLVD
ROCKLEDGE FL
32955-6217
US

IV. Provider business mailing address

270 DEAUVILLE AVE SE
PALM BAY FL
32909-3607
US

V. Phone/Fax

Practice location:
  • Phone: 321-549-3980
  • Fax:
Mailing address:
  • Phone: 321-615-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: