Provider Demographics
NPI:1417402371
Name:LEWIS, STEPHANIE TRAMAINE (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TRAMAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:TRAMAINE
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1215 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4631
Mailing Address - Country:US
Mailing Address - Phone:904-269-8922
Mailing Address - Fax:904-375-0719
Practice Address - Street 1:1215 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4631
Practice Address - Country:US
Practice Address - Phone:904-269-8922
Practice Address - Fax:904-375-0719
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15365224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant