Provider Demographics
NPI:1962576124
Name:CAPEHART, STEPHANIE CAROLE MIZELLE (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CAROLE MIZELLE
Last Name:CAPEHART
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 1:7321 GLENDOWER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1507
Mailing Address - Country:US
Mailing Address - Phone:919-341-3219
Mailing Address - Fax:
Practice Address - Street 1:7321 GLENDOWER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1507
Practice Address - Country:US
Practice Address - Phone:919-341-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301642Medicaid