Basic Information
| Provider Information | |||||||||
| NPI: | 1538356498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | BENJAMIN | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 NW 67TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731164611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052860777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3030 NW EXPRESSWAY | ||||||||
| Address2: | SUITE 809 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059177160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1371 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.