Provider Demographics
NPI:1831493345
Name:SOETARMAN, STEFANI HIRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:HIRA
Last Name:SOETARMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HIRA
Other - Middle Name:N
Other - Last Name:BASUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:48460 FLAGSTAFF PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7709
Mailing Address - Country:US
Mailing Address - Phone:916-595-4567
Mailing Address - Fax:
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-851-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist