Provider Demographics
NPI:1972863546
Name:STONEBRAKER, CATHERINE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:STONEBRAKER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 W 1290 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9214
Mailing Address - Country:US
Mailing Address - Phone:801-560-0008
Mailing Address - Fax:
Practice Address - Street 1:25 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3511
Practice Address - Country:US
Practice Address - Phone:801-785-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7905154-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist