Provider Demographics
NPI:1578242467
Name:SHUMAN, STEPHANIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHUMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5740
Mailing Address - Country:US
Mailing Address - Phone:480-352-9646
Mailing Address - Fax:
Practice Address - Street 1:1550 N STONEHENGE DR STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1244
Practice Address - Country:US
Practice Address - Phone:480-813-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047263224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant