Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XF0002X | Feeding, Eating & Swallowing | 6575 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 6575 | CA |
NPI | 1114221405 |
---|---|
Provider Name | Dr. Stefanie C Bodison |
First Address | Los Angeles, CA 90089-0001 |
Second Address | Los Angeles, CA 90089-4712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2011 |
Last Update Date | 20/12/2018 |