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NPI Code Detail

MEDICARE: STEPHEN RYAN PEARCE OTR/L

MEDICARE: STEPHEN RYAN PEARCE OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT19823FL

General Provider Information

NPI Number : 1215495379
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN RYAN PEARCE OTR/L
Provider Business Mailing Address
First Line : 10475 GANDY BLVD N UNIT 1414
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33702-2450
Country : US
Telephone Number : 612-805-9814
Fax Number :
Provider Business Practice Location Address
First Line : 6000 49TH ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33709-2145
Country : US
Telephone Number : 727-521-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2019
Last Update Date : 03/07/2019

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