Healthcare Provider Details

I. General information

NPI: 1740431139
Provider Name (Legal Business Name): STEPHANIE T. GOCHA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GREEN RIVER RD STE 114
CORONA CA
92878-2306
US

IV. Provider business mailing address

1520 W 18TH ST
UPLAND CA
91784-7448
US

V. Phone/Fax

Practice location:
  • Phone: 951-382-4238
  • Fax:
Mailing address:
  • Phone: 909-702-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number3536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number3536
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: