Provider Demographics
NPI:1346557766
Name:LEDBETTER, STEPHANIE AMBER (OTR/L, MOT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:AMBER
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:FLEMING
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, MOT
Mailing Address - Street 1:7160 TCHULAHOMA RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9266
Mailing Address - Country:US
Mailing Address - Phone:662-349-2733
Mailing Address - Fax:662-536-1849
Practice Address - Street 1:7160 TCHULAHOMA RD BLDG B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9266
Practice Address - Country:US
Practice Address - Phone:662-349-2733
Practice Address - Fax:662-536-1849
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000004077225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics