Individual
DEREK STOCKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.T.A
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
28998 DANIELSON DR, ELKHART, IN 46514-1140
(616) 635-1931
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003059A
IN
Other
Enumeration date
01/26/2017
Last updated
01/26/2017
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