Provider Demographics
NPI:1356676522
Name:MIRANDA AINSWORTH D/B/A STEPPING STONE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:MIRANDA AINSWORTH D/B/A STEPPING STONE PEDIATRIC THERAPY, LLC
Other - Org Name:STEPPING STONE PEDIATRIC THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:256-767-1576
Mailing Address - Street 1:534 E LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4119
Mailing Address - Country:US
Mailing Address - Phone:256-767-1576
Mailing Address - Fax:256-767-1577
Practice Address - Street 1:250 SEVILLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1527
Practice Address - Country:US
Practice Address - Phone:256-767-1576
Practice Address - Fax:256-767-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2846225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty