Provider Demographics
NPI:1053045690
Name:PIERSON, STEPHANIE (OTR, DRS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PIERSON
Suffix:
Gender:F
Credentials:OTR, DRS
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, DRS
Mailing Address - Street 1:2270 INKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9228
Mailing Address - Country:US
Mailing Address - Phone:765-277-2998
Mailing Address - Fax:833-523-2388
Practice Address - Street 1:2270 INKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-9228
Practice Address - Country:US
Practice Address - Phone:765-277-2998
Practice Address - Fax:833-523-2388
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT010764OtherOHIO OCCUPATIONAL THERAPIST LICENSE
IN31006980AOtherINDIANA OCCUPATIONAL THERAPY LICENSE NUMBER
425085OtherNBCOT CERTIFICATION