Basic Information
| Provider Information | |||||||||
| NPI: | 1962977736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUMLIN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HATTAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546148862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083868216 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14345 COUNTY HIGHWAY B | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546564509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082698825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2018 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5532-27 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.