Healthcare Provider Details

I. General information

NPI: 1629339288
Provider Name (Legal Business Name): MS. STEPHANIE PAIGE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ANNABLE CT
CAHOKIA IL
62206-2204
US

IV. Provider business mailing address

308 E RAILROAD AVE
OKAWVILLE IL
62271-2224
US

V. Phone/Fax

Practice location:
  • Phone: 618-332-0114
  • Fax:
Mailing address:
  • Phone: 618-791-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: