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General NPI Number Information
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NPI Number | 1982043469
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Entity Type | Individual
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Provider Name | STEPHANIE HAMPTON C.O.T.A.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 19015 S JODI RD STE A
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City | MOKENA
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State | IL
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Zip | 60448-8534
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Country | US
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Telephone | 708-478-1414
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Fax | 708-478-7786
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Provider Business Mailing Address
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Address Line | 730 W 275 S
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City | HEBRON
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State | IN
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Zip | 46341-9712
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Country | US
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Telephone | 708-567-1247
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Fax | 708-478-7786
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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 | 057001847
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License Number State | IL
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