Provider Demographics
NPI:1831896075
Name:BYCHKOV, STELLA (OTR/L)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:BYCHKOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:KUTSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1517 W GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1517 W GRACE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-499-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61257204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist