Provider Demographics
NPI:1578842290
Name:OKADA, STEPHANIE (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:OKADA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-771-8255
Mailing Address - Fax:916-771-8211
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1105
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-771-8255
Practice Address - Fax:916-771-8211
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11992225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics