Provider Demographics
NPI:1780728410
Name:STEGALL, JACKIE DIANE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:DIANE
Last Name:STEGALL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:DIANE
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:11026 ASBURY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4625
Mailing Address - Country:US
Mailing Address - Phone:704-575-4222
Mailing Address - Fax:
Practice Address - Street 1:11026 ASBURY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4625
Practice Address - Country:US
Practice Address - Phone:704-575-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics