Provider Demographics
NPI:1396921615
Name:STEVENS, STEPHANIE S (MA, OT/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S 4J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5201
Mailing Address - Country:US
Mailing Address - Phone:307-682-2392
Mailing Address - Fax:
Practice Address - Street 1:1801 S 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5201
Practice Address - Country:US
Practice Address - Phone:307-682-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1353225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51402343Medicaid