MEDICARE: LORI KAY STOTKO OTR CHT

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	225XH1200X	Hand Occupational Therapist	521	CA

General Provider Information

NPI Number	:	1932400496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI KAY STOTKO OTR CHT

Provider Business Mailing Address
First Line	:	7 SEA BREEZE DR
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-2313
Country	:	US
Telephone Number	:	650-245-2844
Fax Number	:	650-712-0419

Provider Business Practice Location Address
First Line	:	1155 UNIVERSITY DR
Second Line	:	SUITE 1
City	:	MENLO PARK
State	:	CA
Zip	:	94025-4431
Country	:	US
Telephone Number	:	650-245-2844
Fax Number	:	650-326-5929

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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