Provider Demographics
NPI:1720821200
Name:STOLZ, KYRA ALEXANDRA (OTD)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:ALEXANDRA
Last Name:STOLZ
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1949
Mailing Address - Country:US
Mailing Address - Phone:631-987-7814
Mailing Address - Fax:
Practice Address - Street 1:803 N WAHNETA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2422
Practice Address - Country:US
Practice Address - Phone:601-782-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist