Provider Demographics
NPI:1497486906
Name:CONWAY, STEPHANIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CONWAY
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 1:302 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8922
Mailing Address - Country:US
Mailing Address - Phone:712-898-6320
Mailing Address - Fax:
Practice Address - Street 1:206 PORT NEAL RD
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8098
Practice Address - Country:US
Practice Address - Phone:712-943-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist