Provider Demographics
NPI:1992829147
Name:COE, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BREEZY MDWS
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-8522
Mailing Address - Country:US
Mailing Address - Phone:949-766-8707
Mailing Address - Fax:949-713-9197
Practice Address - Street 1:20902 BAKE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2175
Practice Address - Country:US
Practice Address - Phone:949-600-5437
Practice Address - Fax:949-600-5439
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 706225X00000X
CAOT706225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist