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General NPI Number Information
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NPI Number | 1164982112
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Entity Type | Individual
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Provider Name | JENNA STALNAKER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 03/24/2019
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Provider Practice Location Address
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Address Line | 22 SARASOTA CENTER BLVD
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City | SARASOTA
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State | FL
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Zip | 34240-9770
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Country | US
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Telephone | 941-377-9361
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Fax |
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Provider Business Mailing Address
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Address Line | 890 SEA FOX RD
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City | VENICE
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State | FL
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Zip | 34293-5642
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Country | US
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Telephone | 941-445-7130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT19934
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License Number State | FL
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