Provider Demographics
NPI:1093990418
Name:O'LEARY, STEPHANIE SMITH (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SMITH
Last Name:O'LEARY
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 1:2720 N SWAN RD APT 4A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2001
Mailing Address - Country:US
Mailing Address - Phone:520-884-4711
Mailing Address - Fax:
Practice Address - Street 1:2720 N SWAN RD APT 4A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2001
Practice Address - Country:US
Practice Address - Phone:520-884-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist