Provider Demographics
NPI:1487539474
Name:WHITE, STEPHANIE KAY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:HUTCHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 COVERED BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6104
Mailing Address - Country:US
Mailing Address - Phone:812-381-0689
Mailing Address - Fax:
Practice Address - Street 1:821 W HIGHWAY 50 STE 150
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1828
Practice Address - Country:US
Practice Address - Phone:618-726-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant