Provider Demographics
NPI:1265594303
Name:MAY, STEPHANIE (COTAL)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:YVONNE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTAL
Mailing Address - Street 1:2656 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9158
Mailing Address - Country:US
Mailing Address - Phone:252-355-3839
Mailing Address - Fax:252-756-6331
Practice Address - Street 1:2656 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9158
Practice Address - Country:US
Practice Address - Phone:252-355-3839
Practice Address - Fax:252-756-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3850224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301566Medicaid