Basic Information
| Provider Information | |||||||||
| NPI: | 1114594231 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HOSTUTLER | ||||||||
| FirstName: | JONI | ||||||||
| MiddleName: | B | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 MADEIRA CIR | ||||||||
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| City: | WAXHAW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281737199 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8801 J M KEYNES DR STE 205 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282626418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049714600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 6974 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.