Provider Demographics
NPI:1598379141
Name:EDWARDS, STEPHANIE (OTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 INDIAN TRL STE 140
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5702
Mailing Address - Country:US
Mailing Address - Phone:254-213-2952
Mailing Address - Fax:
Practice Address - Street 1:716 INDIAN TRL STE 140
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-213-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist