Provider Demographics
NPI:1053191874
Name:STOLLER, VICTORIA ANNE (OTD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:STOLLER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E ROSE LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-2142
Mailing Address - Country:US
Mailing Address - Phone:260-445-3224
Mailing Address - Fax:
Practice Address - Street 1:1201 E BEARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3574
Practice Address - Country:US
Practice Address - Phone:574-206-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist