Provider Demographics
NPI:1710321427
Name:CANNADA, STEPHANIE (MOT/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CANNADA
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 S SIWELL RD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9776
Mailing Address - Country:US
Mailing Address - Phone:601-346-9191
Mailing Address - Fax:601-346-3044
Practice Address - Street 1:7213 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-346-9191
Practice Address - Fax:601-346-3044
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2778225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist