Healthcare Provider Details

I. General information

NPI: 1689275562
Provider Name (Legal Business Name): KRISTA STOLL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TOWN AND COUNTRY DR STE A
DANVILLE CA
94526-3965
US

IV. Provider business mailing address

5833 PRESLEY WAY
OAKLAND CA
94618-1601
US

V. Phone/Fax

Practice location:
  • Phone: 925-743-8905
  • Fax:
Mailing address:
  • Phone: 805-402-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number21761
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number21761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: