Healthcare Provider Details

I. General information

NPI: 1194991745
Provider Name (Legal Business Name): STEPHANIE HODGES BARNES CFTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W STADIUM DR
EDEN NC
27288-3329
US

IV. Provider business mailing address

103 W STADIUM DR
EDEN NC
27288-3329
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-4854
  • Fax: 336-627-8925
Mailing address:
  • Phone: 336-627-4854
  • Fax: 336-627-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS0348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: