Provider Demographics
NPI:1952658130
Name:BUFFUM, STEPHANIE (OT 12786)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BUFFUM
Suffix:
Gender:F
Credentials:OT 12786
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 BEACH BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2030
Mailing Address - Country:US
Mailing Address - Phone:714-962-5650
Mailing Address - Fax:714-962-5961
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-962-5650
Practice Address - Fax:714-962-5961
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 12786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist