Healthcare Provider Details

I. General information

NPI: 1932261807
Provider Name (Legal Business Name): STRAIT ORTHOPEDIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PORT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

1112 CAROLINE ST
PORT ANGELES WA
98362-4204
US

V. Phone/Fax

Practice location:
  • Phone: 360-344-3090
  • Fax: 360-344-3089
Mailing address:
  • Phone: 360-417-8630
  • Fax: 360-417-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00038097
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003756
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00003756
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004257
License Number StateWA

VIII. Authorized Official

Name: REGINA MAY MCGOVERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 360-417-8630