Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT9228 | CA |
N | 225XH1200X | Occupational Therapist - Hand | OT9228 | CA |
NPI | 1023212115 |
---|---|
Provider Name | Ms. Kimberly Marie Stephan |
First Address | Torrance, CA 90501-5723 |
Second Address | Torrance, CA 90503-5800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |