Provider Demographics
NPI:1326678764
Name:STOCKTON, COLLETTE MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:MARIE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:MARIE
Other - Last Name:GASPERVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9275 E MOGOLLON TRL
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-4694
Mailing Address - Country:US
Mailing Address - Phone:480-389-7412
Mailing Address - Fax:
Practice Address - Street 1:4535 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7664
Practice Address - Country:US
Practice Address - Phone:602-295-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist