Provider Demographics
NPI:1225435522
Name:THOMAS, STEFANIE LYNNE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:LYNNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 SAVANNAH WAY APT 108
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3639
Mailing Address - Country:US
Mailing Address - Phone:321-794-7833
Mailing Address - Fax:
Practice Address - Street 1:7950 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8229
Practice Address - Country:US
Practice Address - Phone:407-658-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12642224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant