Basic Information
| Provider Information | |||||||||
| NPI: | 1316411739 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STUP | ||||||||
| FirstName: | LORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 197 THOMAS JOHNSON DR STE B | ||||||||
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| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016621997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 605 E CHURCH ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217015705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405663568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 02231 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.