Provider Demographics
NPI:1174505283
Name:STONE, MARIA NENITA (OT RL)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:NENITA
Last Name:STONE
Suffix:
Gender:F
Credentials:OT RL
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:NENITA
Other - Last Name:KACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6115 34TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7205
Mailing Address - Country:US
Mailing Address - Phone:253-265-3958
Mailing Address - Fax:
Practice Address - Street 1:560 LEBO BLVD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2617
Practice Address - Country:US
Practice Address - Phone:360-479-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33280Medicare UPIN