Provider Demographics
NPI:1174955678
Name:STUMPH, LAURI ANN (OT)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:ANN
Last Name:STUMPH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2911 S RAINBOW AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3535
Mailing Address - Country:US
Mailing Address - Phone:612-963-2147
Mailing Address - Fax:
Practice Address - Street 1:1380 S CASTLE DOME AVE STE 104
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2024
Practice Address - Country:US
Practice Address - Phone:928-605-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist