Provider Demographics
NPI:1174259451
Name:STONE, NICHOLAS GIOVANNI (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GIOVANNI
Last Name:STONE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:GIOVANNI
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:16940 KINGSBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7800
Mailing Address - Country:US
Mailing Address - Phone:765-586-0766
Mailing Address - Fax:
Practice Address - Street 1:11570 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9592
Practice Address - Country:US
Practice Address - Phone:317-759-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007794A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist