Provider Demographics
NPI:1972702751
Name:THE LAUREL STOUT AGENCY, L.L.C.
Entity type:Organization
Organization Name:THE LAUREL STOUT AGENCY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTZMAN-STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC, SLP
Authorized Official - Phone:800-577-4310
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-0267
Mailing Address - Country:US
Mailing Address - Phone:800-577-4310
Mailing Address - Fax:937-695-1375
Practice Address - Street 1:19261 STATE ROUTE 136
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697
Practice Address - Country:US
Practice Address - Phone:800-577-4310
Practice Address - Fax:937-695-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02822224Z00000X
OH05442225200000X
OH02711225200000X
OH5546225X00000X
OHSP8282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty