Individual
MIRIAM M STOUT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6506 LOISDALE RD, STE 300, SPRINGFIELD, VA 21550
(703) 924-4100
(783) 922-0638
Mailing address
PO BOX 6603, SPRINGFIELD, VA 22150-6603
(775) 340-4062
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004064
VA
Other
Enumeration date
12/06/2005
Last updated
07/08/2007
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