Provider Demographics
NPI:1952639072
Name:STEPHENSON, AMANDA POWELL (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:POWELL
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NC HWY 55
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8427
Mailing Address - Country:US
Mailing Address - Phone:919-363-5000
Mailing Address - Fax:919-363-5346
Practice Address - Street 1:3100 NC HWY 55
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8427
Practice Address - Country:US
Practice Address - Phone:919-363-5000
Practice Address - Fax:919-363-5346
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist