Provider Demographics
NPI:1295216265
Name:DURST, STEWART DAKOTA (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:DAKOTA
Last Name:DURST
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15920 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1706
Mailing Address - Country:US
Mailing Address - Phone:760-208-5737
Mailing Address - Fax:
Practice Address - Street 1:600 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2630
Practice Address - Country:US
Practice Address - Phone:650-853-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist