Provider Demographics
NPI:1649586546
Name:ELLIOTT, STEPHANIE LYNN (OTR)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 162904
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-2904
Mailing Address - Country:US
Mailing Address - Phone:512-306-1707
Mailing Address - Fax:512-306-7380
Practice Address - Street 1:4613 BEE CAVE RD
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5203
Practice Address - Country:US
Practice Address - Phone:512-306-1707
Practice Address - Fax:512-306-7380
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113728225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist