Provider Demographics
NPI:1891309746
Name:TERRELL, STEPHANIE ALICE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALICE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 TYLERS PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6308
Mailing Address - Country:US
Mailing Address - Phone:513-755-6600
Mailing Address - Fax:513-755-3762
Practice Address - Street 1:4325 RED BANK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2174
Practice Address - Country:US
Practice Address - Phone:513-271-2419
Practice Address - Fax:513-755-3762
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01914225X00000X
RIOT00306-G225X00000X
OHOT011650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOT00306-GOtherRHODE ISLAND DEPARTMENT OF HEALTH
OH0406425Medicaid