=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306014972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA STEGALL LPTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2008
-----------------------------------------------------
Last Update Date | 05/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7235 WHIPPLE AVE NW
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-7137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-498-8200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 E 7TH ST
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45690-1563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-271-0871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA. 03257
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------