Provider Demographics
NPI:1104354844
Name:LEWIS, STEPHANIE NOELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NOELLE
Last Name:LEWIS
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 1:9111 MONROE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2454
Mailing Address - Country:US
Mailing Address - Phone:704-847-3911
Mailing Address - Fax:
Practice Address - Street 1:9111 MONROE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2454
Practice Address - Country:US
Practice Address - Phone:704-847-3911
Practice Address - Fax:704-847-2033
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist