Provider Demographics
NPI:1740341478
Name:STEPHENSON, BECKY KAY (COTA)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:KAY
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7181 GLENROSS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1656
Mailing Address - Country:US
Mailing Address - Phone:651-501-9583
Mailing Address - Fax:
Practice Address - Street 1:640 ELM ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9358
Practice Address - Country:US
Practice Address - Phone:715-684-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI797-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant