Provider Demographics
NPI:1770137648
Name:CSEH, STEFAN (COTA)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:CSEH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 S CARRIAGE LANE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:623-977-4911
Mailing Address - Fax:866-473-0405
Practice Address - Street 1:8765 W KEITON LANE #116
Practice Address - Street 2:
Practice Address - City:PEONA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-977-4911
Practice Address - Fax:866-473-0405
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6957224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant