Provider Demographics
NPI:1841561693
Name:STOLL, JYOTHI (OTR)
Entity Type:Individual
Prefix:MISS
First Name:JYOTHI
Middle Name:
Last Name:STOLL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 CHASEWOOD DR
Mailing Address - Street 2:APT F
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5882
Mailing Address - Country:US
Mailing Address - Phone:703-409-9807
Mailing Address - Fax:
Practice Address - Street 1:6564 CHASEWOOD DR
Practice Address - Street 2:APT F
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5882
Practice Address - Country:US
Practice Address - Phone:703-409-9807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist