Provider Demographics
NPI:1013930742
Name:RUMLEY, STEPHANY CLODEAN (OT /PTA)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:CLODEAN
Last Name:RUMLEY
Suffix:
Gender:F
Credentials:OT /PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 88
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:OK
Mailing Address - Zip Code:73079-9607
Mailing Address - Country:US
Mailing Address - Phone:405-222-5030
Mailing Address - Fax:405-222-5050
Practice Address - Street 1:626 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-3322
Practice Address - Country:US
Practice Address - Phone:405-222-5030
Practice Address - Fax:405-222-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA124225200000X
OKOT124225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$001OtherBCBS PAYOR ID