Provider Demographics
NPI:1487299236
Name:MOTILALL, STEPHANIE HOLLY (OTR/L , OTD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOLLY
Last Name:MOTILALL
Suffix:
Gender:F
Credentials:OTR/L , OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 SW TRENTON LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4322
Mailing Address - Country:US
Mailing Address - Phone:561-797-6001
Mailing Address - Fax:
Practice Address - Street 1:2025 SW TRENTON LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4322
Practice Address - Country:US
Practice Address - Phone:561-797-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist