Provider Demographics
NPI:1336429208
Name:STOLL, CALLIE ANNE (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANNE
Last Name:STOLL
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 SAVANNAH HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1662 SAVANNAH HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2235
Practice Address - Country:US
Practice Address - Phone:843-766-8905
Practice Address - Fax:843-277-2729
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3845225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist