Provider Demographics
NPI:1093316200
Name:STONE, AMY (CPO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5906
Mailing Address - Country:US
Mailing Address - Phone:208-342-4659
Mailing Address - Fax:
Practice Address - Street 1:1912 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5906
Practice Address - Country:US
Practice Address - Phone:208-342-4659
Practice Address - Fax:208-342-8211
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO03767222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO03767OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS