Provider Demographics
NPI:1093023731
Name:STONE, KELLY POPE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:POPE
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 1:663 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POLKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28135-9354
Mailing Address - Country:US
Mailing Address - Phone:704-272-6247
Mailing Address - Fax:
Practice Address - Street 1:663 HIGH ST
Practice Address - Street 2:
Practice Address - City:POLKTON
Practice Address - State:NC
Practice Address - Zip Code:28135-9354
Practice Address - Country:US
Practice Address - Phone:704-272-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant