Individual
ENNON E STOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
420 MISSISSIPPI AVE, ALLIANCE, NE 69301-3447
(308) 638-4483
Mailing address
420 MISSISSIPPI AVE, ALLIANCE, NE 69301-3447
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
855
NE
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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