Provider Demographics
NPI:1982043469
Name:HAMPTON, STEPHANIE (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W 275 S
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-9712
Mailing Address - Country:US
Mailing Address - Phone:708-567-1247
Mailing Address - Fax:708-478-7786
Practice Address - Street 1:19015 S JODI RD STE A
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8534
Practice Address - Country:US
Practice Address - Phone:708-478-1414
Practice Address - Fax:708-478-7786
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001847224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant