Provider Demographics
NPI:1659729705
Name:RALEY, STEPHANIE FARVER (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FARVER
Last Name:RALEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 CARTERS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-1864
Mailing Address - Country:US
Mailing Address - Phone:404-414-6415
Mailing Address - Fax:
Practice Address - Street 1:4249 CARTERS LAKE DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-1864
Practice Address - Country:US
Practice Address - Phone:404-414-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist