Provider Demographics
NPI:1386261667
Name:STOTLER, JAMIE MARIE (BCABA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:STOTLER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 EWELL RD
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-5883
Mailing Address - Country:US
Mailing Address - Phone:334-258-5626
Mailing Address - Fax:
Practice Address - Street 1:1247 RUCKER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3630
Practice Address - Country:US
Practice Address - Phone:334-347-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0-20-11100106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst