Provider Demographics
NPI:1992129837
Name:STOCKHAM, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:STOCKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67422-9019
Mailing Address - Country:US
Mailing Address - Phone:785-577-4000
Mailing Address - Fax:
Practice Address - Street 1:6700 E 45TH ST N
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-8817
Practice Address - Country:US
Practice Address - Phone:785-577-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00713224Z00000X
MO2012018314224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant