| NPI | 1235585837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD DAVID NICKLEN President Stomptherapy, LLC 850-543-7776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 60420) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-05-12 |