Provider Demographics
NPI:1265632806
Name:WOOD, STEPHEN SHANE (MSOTR)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SHANE
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 HOLLY TRACE CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4150
Mailing Address - Country:US
Mailing Address - Phone:615-496-0590
Mailing Address - Fax:
Practice Address - Street 1:VANDERBILT REHABILITATION SERVICES
Practice Address - Street 2:1301 22ND SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37237-0001
Practice Address - Country:US
Practice Address - Phone:615-831-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000002794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist