Provider Demographics
NPI:1306112446
Name:STOLL, CASANDRA MARIE (ATC)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:MARIE
Last Name:STOLL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MATHEWS DR
Mailing Address - Street 2:SUITE D5
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3734
Mailing Address - Country:US
Mailing Address - Phone:843-681-5640
Mailing Address - Fax:843-681-5631
Practice Address - Street 1:95 MATHEWS DR
Practice Address - Street 2:SUITE D5
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3734
Practice Address - Country:US
Practice Address - Phone:843-681-5640
Practice Address - Fax:843-681-5631
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0031132255A2300X
SC13852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer