Provider Demographics
NPI:1346973971
Name:IRVIN, STEPHANIE ADDINGTON (COTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ADDINGTON
Last Name:IRVIN
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 1:1036 ORCHARD GROVES CT APT 102
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4184
Mailing Address - Country:US
Mailing Address - Phone:704-954-4042
Mailing Address - Fax:
Practice Address - Street 1:154 AMENDMENT AVE STE 104
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3156
Practice Address - Country:US
Practice Address - Phone:803-632-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5418224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant