Individual
MR. DARREN MICHAEL STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2814 S INDIANA AVE, CALDWELL, ID 83605-5925
(208) 454-0380
Mailing address
2355 EST MEADOW WOOD DR, MERIDIAN, ID 83646
(208) 863-5568
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA101
ID
Other
Enumeration date
06/12/2008
Last updated
06/12/2008
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