MEDICARE: MRS. STEPHANIE REBEKAH OLDHAM MS, 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
1	225X00000X	Occupational Therapist	OTR1776	AR

General Provider Information

NPI Number	:	1215970439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE REBEKAH OLDHAM MS, OTR/L

Provider Business Mailing Address
First Line	:	1603 N LINCOLN ST
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-2728
Country	:	US
Telephone Number	:	501-843-0618
Fax Number	:	501-257-3110

Provider Business Practice Location Address
First Line	:	2200 FT ROOTS DRIVE
Second Line	:	VA HOSPITAL NLR , BLDG 170,116/N
City	:	N. LITTLE ROCK
State	:	AR
Zip	:	72114-1709
Country	:	US
Telephone Number	:	501-257-3024
Fax Number	:	501-257-3110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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