Provider Demographics
NPI:1326279985
Name:WICK, STEPHANIE SEYMORE (MSOT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SEYMORE
Last Name:WICK
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3104
Mailing Address - Country:US
Mailing Address - Phone:980-721-4839
Mailing Address - Fax:
Practice Address - Street 1:1532 STERLING RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1546
Practice Address - Country:US
Practice Address - Phone:980-721-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist