Individual
STEPHEN STORM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3028 HIGHWAY 348, RUDY, AR 72952-9564
(479) 719-1637
Mailing address
3028 HIGHWAY 348, RUDY, AR 72952-9564
(479) 719-1637
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA817
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201121721
—
AR
Enumeration date
12/11/2013
Last updated
11/18/2015
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