Provider Demographics
NPI:1083195887
Name:WELLS, STEPHANIE YVONNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:YVONNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 S KERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-9016
Mailing Address - Country:US
Mailing Address - Phone:719-469-6708
Mailing Address - Fax:
Practice Address - Street 1:1601 W 44TH PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6376
Practice Address - Country:US
Practice Address - Phone:605-322-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1090225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics