Healthcare Provider Details

I. General information

NPI: 1912817628
Provider Name (Legal Business Name): STEVEN LEE HODGES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 GULF WAY APT 203
ST PETE BEACH FL
33706-4340
US

IV. Provider business mailing address

403 GULF WAY APT 203
ST PETE BEACH FL
33706-4340
US

V. Phone/Fax

Practice location:
  • Phone: 920-698-0736
  • Fax:
Mailing address:
  • Phone: 920-698-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20085
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number59622
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: