Provider Demographics
NPI:1417483462
Name:AMES, STEPHANIE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:AMES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 KAVANAUGH BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4352
Mailing Address - Country:US
Mailing Address - Phone:501-517-0163
Mailing Address - Fax:501-683-7414
Practice Address - Street 1:2801 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1000
Practice Address - Country:US
Practice Address - Phone:501-517-0163
Practice Address - Fax:501-683-7414
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 7072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer