Provider Demographics
NPI:1043754476
Name:WHIGHAM, STEPHANIE CONNER (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CONNER
Last Name:WHIGHAM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SKYLER LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6768
Mailing Address - Country:US
Mailing Address - Phone:919-437-5575
Mailing Address - Fax:
Practice Address - Street 1:118 SKYLER LN
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6768
Practice Address - Country:US
Practice Address - Phone:919-437-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist