MEDICARE: STEPHANIE A CAPSHAW OTR

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	2547	NM
2	225X00000X	Occupational Therapist	109318	TX

General Provider Information

NPI Number	:	1710127105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE A CAPSHAW OTR

Provider Business Mailing Address
First Line	:	5690 SANTA TERESITA DR
Second Line	:	STE. A-1
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9206
Country	:	US
Telephone Number	:	915-603-5019
Fax Number	:	866-830-3399

Provider Business Practice Location Address
First Line	:	5690 SANTA TERESITA DR
Second Line	:	STE. A-1
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9206
Country	:	US
Telephone Number	:	915-603-5019
Fax Number	:	866-830-3399

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

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/25/2009

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Directions to “ STEPHANIE A CAPSHAW OTR” Practice Location

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