Individual
MS. CALLIE LYNN STOCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA, PM
Contact information
Practice address
1505 HICKORY ST, FORT WAYNE, IN 46802-4937
(260) 484-4304
Mailing address
1505 HICKORY ST, FORT WAYNE, IN 46802-4937
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001155A
IN
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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