Provider Demographics
NPI:1780302943
Name:ALTOM, STEPHANIE ELAINE (COTA/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:ALTOM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:540 PRINCE REAPER RD
Mailing Address - Street 2:
Mailing Address - City:PANGBURN
Mailing Address - State:AR
Mailing Address - Zip Code:72121-9762
Mailing Address - Country:US
Mailing Address - Phone:501-305-9455
Mailing Address - Fax:
Practice Address - Street 1:2302 LLAMA DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4793
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:501-268-5443
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant