MEDICARE: STEPHANIE CARUSO AFSHAR OTRL & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	4949	CA

General Provider Information

NPI Number	:	1790904654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE CARUSO AFSHAR OTRL & ASSOCIATES

Provider Business Mailing Address
First Line	:	239 S BARRINGTON AVE # 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3318
Country	:	US
Telephone Number	:	310-612-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 S BARRINGTON AVE # 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3318
Country	:	US
Telephone Number	:	310-612-6146
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	PROF. STEPHANIE CARUSO AFSHAR
Credential	:	OTR
Telephone Number	:	310-612-6146

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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