Individual
RICKY STIEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
100 E FERGUSON ST, 1204, TYLER, TX 75702-5759
(903) 509-2040
Mailing address
100 E FERGUSON ST, 1204, TYLER, TX 75702-5759
(903) 509-2040
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210619
TX
Other
Enumeration date
03/14/2014
Last updated
03/14/2014
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