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General NPI Number Information
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NPI Number | 1740157791
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Entity Type | Individual
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Provider Name | STEPHANIE MITCHELL WARDELL OTA
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Gender | Female
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 13540 17TH ST
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City | DADE CITY
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State | FL
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Zip | 33525-5244
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Country | US
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Telephone | 352-437-5151
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Fax | 813-212-3870
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Provider Business Mailing Address
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Address Line | 5809 JUSTICIA LOOP
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City | LAND O LAKES
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State | FL
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Zip | 34639-2711
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Country | US
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Telephone | 281-798-2391
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Fax | 813-212-3870
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA20406
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License Number State | FL
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