Provider Demographics
NPI:1568670057
Name:STONESTREET, SCOTT (OTRL)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:STONESTREET
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 VAUCLUSE LN
Mailing Address - Street 2:
Mailing Address - City:MACHIPONGO
Mailing Address - State:VA
Mailing Address - Zip Code:23405-2301
Mailing Address - Country:US
Mailing Address - Phone:757-442-5222
Mailing Address - Fax:757-442-6333
Practice Address - Street 1:36082 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-5222
Practice Address - Fax:757-442-6333
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist