Provider Demographics
NPI:1063074029
Name:STOVALL, JOCELYN DAVIS (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:DAVIS
Last Name:STOVALL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 680306
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-0306
Mailing Address - Country:US
Mailing Address - Phone:334-595-5625
Mailing Address - Fax:
Practice Address - Street 1:1804 COVENTRY CT
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5598
Practice Address - Country:US
Practice Address - Phone:334-462-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15096225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist