Healthcare Provider Details

I. General information

NPI: 1528291846
Provider Name (Legal Business Name): STEPHEN JOHN HUFFSTUTLER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 MISSION RD
EDMOND OK
73034-6825
US

IV. Provider business mailing address

2248 MISSION RD
EDMOND OK
73034-6825
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-5711
  • Fax:
Mailing address:
  • Phone: 405-359-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number55
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: