Provider Demographics
NPI:1326211368
Name:ESTES, STEPHANIE DAWN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:ESTES
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 1:1221 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0730
Mailing Address - Country:US
Mailing Address - Phone:931-510-6085
Mailing Address - Fax:
Practice Address - Street 1:815 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5956
Practice Address - Country:US
Practice Address - Phone:931-646-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN898224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant