Healthcare Provider Details

I. General information

NPI: 1255146361
Provider Name (Legal Business Name): BENJAMIN STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PARK ST
MADISON WI
53715-1375
US

IV. Provider business mailing address

111 HOOVER ST
SUN PRAIRIE WI
53590-1407
US

V. Phone/Fax

Practice location:
  • Phone: 608-890-6170
  • Fax:
Mailing address:
  • Phone: 715-419-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: