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General NPI Number Information
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NPI Number | 1114221405
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Entity Type | Individual
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Provider Name | STEFANIE C BODISON OTD
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Gender | Female
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Dates
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Enumeration Date | 01/01/2011
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 1540 ALCAZAR ST CENTER FOR HEALTH PROFESSIONS (CHP) 133
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City | LOS ANGELES
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State | CA
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Zip | 90089-4712
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Country | US
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Telephone | 310-990-3729
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 ACAZAR CHP 133
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City | LOS ANGELES
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State | CA
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Zip | 90089-0001
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Country | US
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Telephone | 310-990-3729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 6575
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number | 6575
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License Number State | CA
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