Provider Demographics
NPI:1902489883
Name:LUNDY, STEPHANIE KRISTEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KRISTEN
Last Name:LUNDY
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 1:7349 HONEYSUCKLE STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5888
Mailing Address - Country:US
Mailing Address - Phone:254-780-9658
Mailing Address - Fax:
Practice Address - Street 1:7349 HONEYSUCKLE STE 100
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5888
Practice Address - Country:US
Practice Address - Phone:254-780-9658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120962225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics