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General NPI Number Information
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NPI Number | 1922570225
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Entity Type | Individual
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Provider Name | STACEY ANN SEIDMAN OTR
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Gender | Female
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 5445 EVERGLADES ST
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City | VENTURA
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State | CA
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Zip | 93003-6523
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Country | US
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Telephone | 805-642-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 737 CONGRESSIONAL RD
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6603
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Country | US
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Telephone | 818-634-7857
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 15592
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 15592
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 15592
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License Number State | CA
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