MEDICARE: CAROL ANN STOOPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1144382888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN STOOPS

Provider Business Mailing Address
First Line	:	PO BOX 48116
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32247-8116
Country	:	US
Telephone Number	:	904-725-1657
Fax Number	:	904-725-7247

Provider Business Practice Location Address
First Line	:	880 A1A N STE 18A
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3221
Country	:	US
Telephone Number	:	904-725-1657
Fax Number	:	904-725-7247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROL ANN STOOPS ” Practice Location

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