Healthcare Provider Details

I. General information

NPI: 1477976678
Provider Name (Legal Business Name): MICHELLE STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 HUGHES RD
HOUSTON OH
45333-9799
US

IV. Provider business mailing address

8050 HUGHES RD
HOUSTON OH
45333-9799
US

V. Phone/Fax

Practice location:
  • Phone: 937-493-0542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: