Healthcare Provider Details

I. General information

NPI: 1346104189
Provider Name (Legal Business Name): STEPHANIE LO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E PONCE DE LEON BLVD APT 1102
CORAL GABLES FL
33134-3169
US

IV. Provider business mailing address

911 E PONCE DE LEON BLVD APT 1102
CORAL GABLES FL
33134-3169
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-6215
  • Fax:
Mailing address:
  • Phone: 718-612-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: