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General NPI Number Information
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NPI Number | 1164708442
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Entity Type | Individual
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Provider Name | MARIA NICOLE STEPHENS MARIA STEPHENS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 105 WAXHAW PROFESSIONAL PARK DR
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City | WAXHAW
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State | NC
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Zip | 28173-5017
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Country | US
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Telephone | 704-251-9112
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Fax | 704-684-4644
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Provider Business Mailing Address
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Address Line | 3212 PLANTERS RIDGE RD
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City | CHARLOTTE
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State | NC
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Zip | 28270-1619
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Country | US
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Telephone | 704-845-0459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4723
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2360
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License Number State | NC
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