Provider Demographics
NPI:1326243080
Name:KINARD-SUBER, STEPHANIE SABRINA (OTR)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:SABRINA
Last Name:KINARD-SUBER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:113 WESTSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4663
Mailing Address - Country:US
Mailing Address - Phone:706-951-8052
Mailing Address - Fax:
Practice Address - Street 1:1002 STEEPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8041
Practice Address - Country:US
Practice Address - Phone:803-271-2364
Practice Address - Fax:803-708-5618
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist