Healthcare Provider Details

I. General information

NPI: 1629904891
Provider Name (Legal Business Name): EMMA STOCKSTILL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 STONEHILL RD
JEFFERSON CITY MO
65101-2110
US

IV. Provider business mailing address

424 KENSINGTON PARK APT B
JEFFERSON CITY MO
65109-6269
US

V. Phone/Fax

Practice location:
  • Phone: 573-634-3070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: