Provider Demographics
NPI:1902815251
Name:ADAM, STEPHANIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:DURRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10791 S 72ND ST
Mailing Address - Street 2:SUTIE C
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3423
Mailing Address - Country:US
Mailing Address - Phone:402-932-2782
Mailing Address - Fax:
Practice Address - Street 1:10791 S 72ND ST
Practice Address - Street 2:SUTIE C
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3423
Practice Address - Country:US
Practice Address - Phone:402-932-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3614784201225X00000X
NE1257225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3614784201OtherUTAH STATE LICENSE
NE1257OtherNEBRASKA STATE LICENSE