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General NPI Number Information
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NPI Number | 1174939524
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Entity Type | Individual
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Provider Name | JOHANKA STAVENIK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 5701 SW MULTNOMAH BLVD
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City | PORTLAND
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State | OR
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Zip | 97219-3195
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Country | US
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Telephone | 503-244-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE SUITE D
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone | 971-224-2004
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number |
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License Number State |
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