Provider Demographics
NPI:1033379185
Name:HALE, STEPHANIE ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:HALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 KAYLA LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-7619
Mailing Address - Country:US
Mailing Address - Phone:903-323-6572
Mailing Address - Fax:903-323-6564
Practice Address - Street 1:3133 GOOD SHEPHERD WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4661
Practice Address - Country:US
Practice Address - Phone:903-323-6572
Practice Address - Fax:903-323-6564
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist