Individual
MISS STEPHANIE RENEA MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
714 W GROVE ST, EL DORADO, AR 71730-4416
(870) 863-8194
Mailing address
2205 W ELM ST, EL DORADO, AR 71730-5278
(870) 918-6933
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR970
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X392
ABCBS
AR
Enumeration date
06/22/2007
Last updated
11/06/2023
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