Provider Demographics
NPI:1992461537
Name:STEWARD, EBONY (COTA)
Entity type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:STEWARD
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 1:4110 TRAVIS ST APT B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1887
Mailing Address - Country:US
Mailing Address - Phone:214-669-0218
Mailing Address - Fax:
Practice Address - Street 1:963 W YELLOWJACKET LN
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4950
Practice Address - Country:US
Practice Address - Phone:972-722-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215715224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant