Provider Demographics
NPI:1710153085
Name:STEDDOM, TRISHA LYNN
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:LYNN
Last Name:STEDDOM
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 1:2744 OCEAN DR
Mailing Address - Street 2:APT. B
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6390
Mailing Address - Country:US
Mailing Address - Phone:904-624-0424
Mailing Address - Fax:
Practice Address - Street 1:801 28TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-1955
Practice Address - Country:US
Practice Address - Phone:563-243-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist