Provider Demographics
NPI:1427525427
Name:ORTEGO, STEPHANIE E (COTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:ORTEGO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 OAK HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6648
Mailing Address - Country:US
Mailing Address - Phone:704-579-1047
Mailing Address - Fax:
Practice Address - Street 1:4121 OAK HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-6648
Practice Address - Country:US
Practice Address - Phone:704-579-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5193224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5193OtherSTATE LICENSE