Provider Demographics
NPI:1457910390
Name:STONE, NICOLE ALEXIS (BS, ITFS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXIS
Last Name:STONE
Suffix:
Gender:F
Credentials:BS, ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 STUDBURY HALL CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9800
Mailing Address - Country:US
Mailing Address - Phone:919-609-5643
Mailing Address - Fax:919-400-4334
Practice Address - Street 1:4820 STUDBURY HALL CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9800
Practice Address - Country:US
Practice Address - Phone:919-609-5643
Practice Address - Fax:919-400-4334
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty