Basic Information
| Provider Information | |||||||||
| NPI: | 1306112446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOLL | ||||||||
| FirstName: | CASANDRA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MATHEWS DR | ||||||||
| Address2: | SUITE D5 | ||||||||
| City: | HILTON HEAD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299263734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436815640 | ||||||||
| FaxNumber: | 8436815631 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MATHEWS DR | ||||||||
| Address2: | SUITE D5 | ||||||||
| City: | HILTON HEAD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299263734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436815640 | ||||||||
| FaxNumber: | 8436815631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2012 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096.003113 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | 1385 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.