Provider Demographics
NPI:1154540003
Name:AFSHAR, STEPHANIE CARUSO (OTR)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CARUSO
Last Name:AFSHAR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:PROF
Other - First Name:STEPHANIE
Other - Middle Name:CARUSO
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OCCUPATIONAL THERAPY
Mailing Address - Street 1:239 S BARRINGTON AVE # 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3318
Mailing Address - Country:US
Mailing Address - Phone:310-612-6146
Mailing Address - Fax:
Practice Address - Street 1:239 S BARRINGTON AVE # 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3318
Practice Address - Country:US
Practice Address - Phone:310-612-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist