Provider Demographics
NPI:1366950115
Name:TATEM-PAIGE, STEPHANIE EMMA (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:EMMA
Last Name:TATEM-PAIGE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17523 DORIS ST
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3167
Mailing Address - Country:US
Mailing Address - Phone:352-615-5230
Mailing Address - Fax:
Practice Address - Street 1:617 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2602
Practice Address - Country:US
Practice Address - Phone:352-805-4404
Practice Address - Fax:352-805-4407
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist