1740345412 NPI number — STEPHANIE MARIE FOSTER OTR/L, PHD

Table of content: STEPHANIE MARIE FOSTER OTR/L, PHD (NPI 1740345412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740345412 NPI number — STEPHANIE MARIE FOSTER OTR/L, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
STEPHANIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740345412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/23/2017
NPI Reactivation Date:
12/31/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93457-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-815-5634
Provider Business Mailing Address Fax Number:
949-215-4281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
734 RICHMIND CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93455-7133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-815-5634
Provider Business Practice Location Address Fax Number:
949-215-4281
Provider Enumeration Date:
12/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT3616 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT3616 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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