Provider Demographics
NPI:1578979134
Name:MELO, STEFANIE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:MELO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:5073 SNOWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0759
Mailing Address - Country:US
Mailing Address - Phone:909-782-2528
Mailing Address - Fax:
Practice Address - Street 1:5073 SNOWBERRY DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0759
Practice Address - Country:US
Practice Address - Phone:909-782-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 14392225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics