Provider Demographics
NPI:1891127577
Name:PETERS, STEPHANIE KAYE (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAYE
Last Name:PETERS
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MONTEREY OAKS BLVD
Mailing Address - Street 2:APARTMENT #1115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4400
Mailing Address - Country:US
Mailing Address - Phone:713-550-3699
Mailing Address - Fax:
Practice Address - Street 1:906 FARM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3310
Practice Address - Country:US
Practice Address - Phone:512-321-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist