Provider Demographics
NPI:1376963835
Name:STUMPER, JOANNA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:STUMPER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 THORNDIKE ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5873
Mailing Address - Country:US
Mailing Address - Phone:516-982-0956
Mailing Address - Fax:
Practice Address - Street 1:1 VARY WAY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1720
Practice Address - Country:US
Practice Address - Phone:516-982-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist