1649586546 NPI number — MISS STEPHANIE LYNN ELLIOTT OTR

Table of content: MISS STEPHANIE LYNN ELLIOTT OTR (NPI 1649586546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649586546 NPI number — MISS STEPHANIE LYNN ELLIOTT OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
STEPHANIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649586546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162904
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-306-1707
Provider Business Mailing Address Fax Number:
512-306-7380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4613 BEE CAVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-306-1707
Provider Business Practice Location Address Fax Number:
512-306-7380
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  113728 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 113728 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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