Provider Demographics
NPI:1649099672
Name:STOUT, LYDIA GRACE (OTR/L, MSOT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:STOUT
Suffix:
Gender:F
Credentials:OTR/L, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 220TH ST SW STE 205
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2169
Mailing Address - Country:US
Mailing Address - Phone:425-712-1978
Mailing Address - Fax:425-712-1995
Practice Address - Street 1:6912 220TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2169
Practice Address - Country:US
Practice Address - Phone:425-712-1978
Practice Address - Fax:425-712-1995
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61601432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist