Provider Demographics
NPI:1679818751
Name:STOOPS, CARLA SUE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SUE
Last Name:STOOPS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:WA
Mailing Address - Zip Code:98932-9715
Mailing Address - Country:US
Mailing Address - Phone:509-895-9383
Mailing Address - Fax:
Practice Address - Street 1:1110 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2197
Practice Address - Country:US
Practice Address - Phone:509-836-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000506224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant