Provider Demographics
NPI:1679249031
Name:YEAGLE, STEPHANIE ONE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ONE
Last Name:YEAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 TURNBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6168
Mailing Address - Country:US
Mailing Address - Phone:252-341-9944
Mailing Address - Fax:
Practice Address - Street 1:1314 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2286
Practice Address - Country:US
Practice Address - Phone:252-341-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist