Provider Demographics
NPI:1740345412
Name:FOSTER, STEPHANIE MARIE (OTR/L, PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OTR/L, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2443
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93457-2443
Mailing Address - Country:US
Mailing Address - Phone:805-815-5634
Mailing Address - Fax:949-215-4281
Practice Address - Street 1:734 RICHMIND CT
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-7133
Practice Address - Country:US
Practice Address - Phone:805-815-5634
Practice Address - Fax:949-215-4281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2019-01-15
Deactivation Date:2017-08-23
Deactivation Code:
Reactivation Date:2018-12-31
Provider Licenses
StateLicense IDTaxonomies
CAOT3616225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161653557OtherTIN