MEDICARE: STEPHANIE HOLLY MOTILALL OTR/L , OTD

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	20429	FL

General Provider Information

NPI Number	:	1487299236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HOLLY MOTILALL OTR/L , OTD

Provider Business Mailing Address
First Line	:	2025 SW TRENTON LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4322
Country	:	US
Telephone Number	:	561-797-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 SW TRENTON LN
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4322
Country	:	US
Telephone Number	:	561-797-6001
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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