Healthcare Provider Details

I. General information

NPI: 1164189601
Provider Name (Legal Business Name): STEPHANIE C SHEYNERMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE C WILLIAMS COTA

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 CLEVELAND AVE STE 101-B
EAST POINT GA
30344-6965
US

IV. Provider business mailing address

122 W TRINITY PL APT 1606
DECATUR GA
30030-3678
US

V. Phone/Fax

Practice location:
  • Phone: 678-322-8255
  • Fax:
Mailing address:
  • Phone: 917-704-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: