Healthcare Provider Details

I. General information

NPI: 1326905654
Provider Name (Legal Business Name): ALICIA STUFOSO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA M STUFOSO OTD

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CHURCH ST
MONROE NC
28112-4804
US

IV. Provider business mailing address

1428 LESTER CIR
WAXHAW NC
28173-0329
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-9898
  • Fax: 704-282-2171
Mailing address:
  • Phone: 626-833-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12715
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: