Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31005266A | IN |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31005266A | IN |
NPI | 1396080545 |
---|---|
Provider Name | Mrs. Crystal Lynn Stephen |
First Address | Dillsboro, IN 47018-9418 |
Second Address | Dillsboro, IN 47018-9418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2012 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100273840 | (05) | IN |