=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093316200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY STONE CPO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2020
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1912 E FRANKLIN RD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-5906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-342-4659
-----------------------------------------------------
Fax | 208-342-8211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1912 E FRANKLIN RD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-5906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-342-4659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Z00000X
-----------------------------------------------------
Taxonomy Name | Orthotist
-----------------------------------------------------
License Number | CPO03767
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | CPO03767
-----------------------------------------------------
License Number State |
-----------------------------------------------------