Provider Demographics
NPI:1063781581
Name:STEVENS, CALVIN BRENT (COTA)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:BRENT
Last Name:STEVENS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7588 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8002
Mailing Address - Country:US
Mailing Address - Phone:765-491-4781
Mailing Address - Fax:
Practice Address - Street 1:7588 MICHAEL LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8002
Practice Address - Country:US
Practice Address - Phone:765-491-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001872A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant