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General NPI Number Information
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NPI Number | 1306244736
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Entity Type | Individual
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Provider Name | SCOTT STASZAK II
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Gender | Male
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 3727 WILDER RD STE A&B
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City | BAY CITY
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State | MI
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Zip | 48706-2367
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Country | US
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Telephone | 989-980-9747
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Fax |
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Provider Business Mailing Address
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Address Line | 500 HANCOCK ST
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City | SAGINAW
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State | MI
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Zip | 48602-4224
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Country | US
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Telephone |
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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 | 5201009073
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License Number State | MI
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