Provider Demographics
NPI:1679891386
Name:LA FAY, STEFANY LYNN (COTA)
Entity type:Individual
Prefix:MS
First Name:STEFANY
Middle Name:LYNN
Last Name:LA FAY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:105 N 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446
Mailing Address - Country:US
Mailing Address - Phone:580-795-3301
Mailing Address - Fax:580-795-7307
Practice Address - Street 1:3600 34TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3800
Practice Address - Country:US
Practice Address - Phone:813-346-1002
Practice Address - Fax:813-200-3370
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL10648224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant