Provider Demographics
NPI:1972713113
Name:TRELFA, STEVEN (OTRL, LMT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TRELFA
Suffix:
Gender:M
Credentials:OTRL, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7639 BROOKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5601
Mailing Address - Country:US
Mailing Address - Phone:901-490-9223
Mailing Address - Fax:662-393-2010
Practice Address - Street 1:7639 BROOKWOOD PL
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5601
Practice Address - Country:US
Practice Address - Phone:901-490-9223
Practice Address - Fax:662-393-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMT852225700000X
MSOT1893225X00000X
AROTR451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S267Medicare UPIN