Individual
STEPHANIE ROSE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3009 N PRINCE ST # 46, CLOVIS, NM 88101-3842
(217) 415-0855
Mailing address
4969 BIG SKY RD, FORT SUMNER, NM 88119-9120
(806) 543-6920
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
122620
TX
Other
Enumeration date
12/15/2022
Last updated
07/22/2023
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