Individual
MRS. STEPHANIE JENAE DORTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
809 WINDLASS CV, BRANDON, MS 39047-7035
(601) 720-7206
Mailing address
5155 KAYWOOD CIR, JACKSON, MS 39211-4609
(601) 594-8242
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
TA2010
MS
225X00000X
Occupational Therapist
Primary
OT3608
MS
Other
Enumeration date
03/06/2015
Last updated
09/20/2021
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