Provider Demographics
NPI:1134326580
Name:STEPHENS, CHRISTINA MASHEA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MASHEA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3471
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3471
Mailing Address - Country:US
Mailing Address - Phone:606-274-8029
Mailing Address - Fax:606-677-1925
Practice Address - Street 1:200 NORFLEET DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1952
Practice Address - Country:US
Practice Address - Phone:606-678-5104
Practice Address - Fax:606-677-1925
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A2678224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant