Healthcare Provider Details

I. General information

NPI: 1992829147
Provider Name (Legal Business Name): STEPHANIE COE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20902 BAKE PKWY SUITE 100
LAKE FOREST CA
92630-2175
US

IV. Provider business mailing address

18 BREEZY MDWS
RANCHO SANTA MARGARITA CA
92688-8522
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-5437
  • Fax: 949-600-5439
Mailing address:
  • Phone: 949-766-8707
  • Fax: 949-713-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 706
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: