MEDICARE: SOPHIE STOTTER

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	:	1205516507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE STOTTER

Provider Business Mailing Address
First Line	:	628 CALAIS CIR
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3905
Country	:	US
Telephone Number	:	847-912-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 MARSEILLES ST
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4147
Country	:	US
Telephone Number	:	847-702-1542
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ SOPHIE STOTTER ” Practice Location

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