Healthcare Provider Details

I. General information

NPI: 1972713113
Provider Name (Legal Business Name): STEVEN TRELFA OTRL, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7639 BROOKWOOD PL
SOUTHAVEN MS
38671-5601
US

IV. Provider business mailing address

7639 BROOKWOOD PL
SOUTHAVEN MS
38671-5601
US

V. Phone/Fax

Practice location:
  • Phone: 901-490-9223
  • Fax: 662-393-2010
Mailing address:
  • Phone: 901-490-9223
  • Fax: 662-393-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT852
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1893
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR451
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: