Provider Demographics
NPI:1700325172
Name:POWERS-STEPHENSON, MOLLY REBECCA
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:REBECCA
Last Name:POWERS-STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:REBECCA
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:430 N VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3221
Mailing Address - Country:US
Mailing Address - Phone:316-807-4912
Mailing Address - Fax:
Practice Address - Street 1:1803 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1611
Practice Address - Country:US
Practice Address - Phone:316-807-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist