Individual
DR. STEPHANIE LEIGH PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, OTR, ATC
Contact information
Practice address
1029 POWDERHORN RD, SIMPSONVILLE, SC 29681-3379
(843) 670-7643
Mailing address
1029 POWDERHORN RD, SIMPSONVILLE, SC 29681-3379
(843) 670-7643
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9750
SC
2255A2300X
Athletic Trainer
3689
FL
225X00000X
Occupational Therapist
17596
FL
225X00000X
Occupational Therapist
5988
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5988
OCCUPATIONAL THERAPY LICENSE
SC
Enumeration date
08/22/2017
Last updated
11/09/2020
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