Provider Demographics
NPI:1811957301
Name:STEPHENSON, AMY JANE (MS, ATC, CSCS)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JANE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 WADDELL RD
Mailing Address - Street 2:APT. B14
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6465
Mailing Address - Country:US
Mailing Address - Phone:843-521-1970
Mailing Address - Fax:843-521-0908
Practice Address - Street 1:1076 RIBAUT RD
Practice Address - Street 2:STE. 102
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5476
Practice Address - Country:US
Practice Address - Phone:843-521-1970
Practice Address - Fax:843-521-0908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer