Basic Information
| Provider Information | |||||||||
| NPI: | 1184151698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | MALEAH | ||||||||
| MiddleName: | MILLER | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 EARL FRYE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623276705 | ||||||||
| FaxNumber: | 6623273760 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 HIGHWAY 278 E STE A | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622574048 | ||||||||
| FaxNumber: | 6622574080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT3300 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.