Provider Demographics
NPI:1992107650
Name:BOBELL, STIEV OWEN (OTR/L)
Entity type:Individual
Prefix:
First Name:STIEV
Middle Name:OWEN
Last Name:BOBELL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1852
Mailing Address - Country:US
Mailing Address - Phone:510-531-8149
Mailing Address - Fax:
Practice Address - Street 1:1024 LARCH AVE
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1852
Practice Address - Country:US
Practice Address - Phone:510-531-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist