Provider Demographics
NPI:1508569393
Name:WU, STEPHANIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W BEVERLY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4265
Mailing Address - Country:US
Mailing Address - Phone:562-927-5820
Mailing Address - Fax:
Practice Address - Street 1:17042 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5950
Practice Address - Country:US
Practice Address - Phone:562-927-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT23611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist