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General NPI Number Information
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NPI Number | 1821514860
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Entity Type | Individual
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Provider Name | STEPHANIE LEIGH PETERSON DPT, OTR, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 1029 POWDERHORN RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3379
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Country | US
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Telephone | 843-670-7643
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 POWDERHORN RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3379
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Country | US
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Telephone | 843-670-7643
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3689
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License Number State | FL
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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 | 17596
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5988
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9750
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License Number State | SC
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