Provider Demographics
NPI:1457402950
Name:STEPHENSON, CAROLYN (OTR-L)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PATTON CEMETARY RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2320
Mailing Address - Country:US
Mailing Address - Phone:828-243-1192
Mailing Address - Fax:
Practice Address - Street 1:2550 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE C
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7972
Practice Address - Country:US
Practice Address - Phone:828-692-0207
Practice Address - Fax:828-692-9945
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4132225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12389OtherBC-BS
NC7301341Medicaid