Provider Demographics
NPI:1215970439
Name:OLDHAM, STEPHANIE REBEKAH (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:REBEKAH
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1603 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2728
Mailing Address - Country:US
Mailing Address - Phone:501-843-0618
Mailing Address - Fax:501-257-3110
Practice Address - Street 1:2200 FT ROOTS DRIVE
Practice Address - Street 2:VA HOSPITAL NLR , BLDG 170,116/N
Practice Address - City:N. LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3024
Practice Address - Fax:501-257-3110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist