Provider Demographics
NPI:1801518493
Name:FORSYTHE, STEPHANY LAUREN
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:LAUREN
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17408 MATINAL RD APT 3811
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1384
Mailing Address - Country:US
Mailing Address - Phone:443-362-8664
Mailing Address - Fax:
Practice Address - Street 1:13223 BLACK MOUNTAIN RD # 1358
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2698
Practice Address - Country:US
Practice Address - Phone:443-362-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist