Provider Demographics
NPI:1518571777
Name:STONE, JARED (BS, COTA/L)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:BS, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 QUILL CT
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6298
Mailing Address - Country:US
Mailing Address - Phone:770-533-1178
Mailing Address - Fax:
Practice Address - Street 1:2036 QUILL CT
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6298
Practice Address - Country:US
Practice Address - Phone:770-533-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant