Provider Demographics
NPI:1215336805
Name:DR. STEPHANIE FOSTER, PHD, OTR/L
Entity type:Organization
Organization Name:DR. STEPHANIE FOSTER, PHD, OTR/L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-215-5008
Mailing Address - Street 1:PO BOX 2476
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93457-2476
Mailing Address - Country:US
Mailing Address - Phone:805-264-1553
Mailing Address - Fax:949-215-4281
Practice Address - Street 1:652 WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-6099
Practice Address - Country:US
Practice Address - Phone:805-264-1553
Practice Address - Fax:949-215-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3616225XF0002X, 225XP0200X
CASP20089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77913YOtherBS GROUP - OT
CAZZZ78575YOtherBS GROUP - SPEECH