Healthcare Provider Details

I. General information

NPI: 1043680580
Provider Name (Legal Business Name): STEPHANIE USSERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 09/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11838 BERNARDO PLAZA CT STE 110
SAN DIEGO CA
92128-2414
US

IV. Provider business mailing address

17427 CAMINITO CALDO
SAN DIEGO CA
92127-1117
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: