Provider Demographics
NPI:1336412584
Name:STAVROS, YESENIA B (OTR/L)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:B
Last Name:STAVROS
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 1:4725 EAVES LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4036
Mailing Address - Country:US
Mailing Address - Phone:786-426-0636
Mailing Address - Fax:
Practice Address - Street 1:1212 MANN DR STE 200
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5511
Practice Address - Country:US
Practice Address - Phone:980-262-3007
Practice Address - Fax:980-262-3528
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist