Healthcare Provider Details

I. General information

NPI: 1497136170
Provider Name (Legal Business Name): LAWRENCE STEVENSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 TASKER ST APT 2
PHILADELPHIA PA
19148-1127
US

IV. Provider business mailing address

1121 TASKER ST APT 2
PHILADELPHIA PA
19148-1127
US

V. Phone/Fax

Practice location:
  • Phone: 267-872-0322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC011244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: