Provider Demographics
NPI:1942597448
Name:FAIN-JONES, STEPHANIE RAYE (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAYE
Last Name:FAIN-JONES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 S MILLER RD APT 4
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4123
Mailing Address - Country:US
Mailing Address - Phone:234-678-8733
Mailing Address - Fax:
Practice Address - Street 1:168 S MILLER RD APT 4
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4123
Practice Address - Country:US
Practice Address - Phone:234-678-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA #00810224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant