Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT.0002519 | CO |
NPI | 1063838415 |
---|---|
Provider Name | Regina Stephan |
First Address | Colorado Springs, CO 80920-7632 |
Second Address | Pueblo, CO 81008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 10/03/2014 |