Provider Demographics
NPI:1932426053
Name:STONE, COREYSHA (COTA/L)
Entity type:Individual
Prefix:
First Name:COREYSHA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4573
Mailing Address - Country:US
Mailing Address - Phone:207-322-5375
Mailing Address - Fax:
Practice Address - Street 1:18 MILLER ST
Practice Address - Street 2:
Practice Address - City:WOOLWICH
Practice Address - State:ME
Practice Address - Zip Code:04579-4573
Practice Address - Country:US
Practice Address - Phone:207-322-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0A2368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant