Provider Demographics
NPI:1184151698
Name:STEPHENS, MALEAH MILLER (OT)
Entity type:Individual
Prefix:
First Name:MALEAH
Middle Name:MILLER
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EARL FRYE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5516
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-3760
Practice Address - Street 1:1111 HIGHWAY 278 E STE A
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5627
Practice Address - Country:US
Practice Address - Phone:662-257-4048
Practice Address - Fax:662-257-4080
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist