Provider Demographics
NPI:1487673604
Name:REYNER, STEPHANIE H (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:H
Last Name:REYNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 IVY ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9389
Mailing Address - Country:US
Mailing Address - Phone:770-844-0206
Mailing Address - Fax:770-844-4487
Practice Address - Street 1:980 IVY ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9389
Practice Address - Country:US
Practice Address - Phone:770-844-0206
Practice Address - Fax:770-844-4487
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004688225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics