Provider Demographics
NPI:1932591781
Name:WELCH, STEPHANIE DAVIDSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAVIDSON
Last Name:WELCH
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 1:529 SUNDANCER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3957
Mailing Address - Country:US
Mailing Address - Phone:865-599-3124
Mailing Address - Fax:
Practice Address - Street 1:120 CAVETTE HILL LN
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-6673
Practice Address - Country:US
Practice Address - Phone:865-777-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist