Individual
DIANA DOROTHY STOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOT, OTR/L
Contact information
Practice address
75 NATHAN DR, BOHEMIA, NY 11716-1317
(631) 704-7079
Mailing address
75 NATHAN DR, BOHEMIA, NY 11716-1317
(631) 704-7079
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
023106
NY
Other
Enumeration date
11/12/2018
Last updated
11/12/2018
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