Basic Information
| Provider Information | |||||||||
| NPI: | 1043652670 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MAY | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 TRINITY LN N | ||||||||
| Address2: | APT 8103 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337161278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709065341 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2130 E BAY DR | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337712323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275870582 | ||||||||
| FaxNumber: | 7275870583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2013 | ||||||||
| LastUpdateDate: | 07/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 8769 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 005496 | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OT17080 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 015012200 | 05 | FL | MEDICAID |