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General NPI Number Information
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NPI Number | 1376716597
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Entity Type | Organization
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Legal Business Name | STRAIT ORTHOPEDIC SPECIALISTS, PS
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 520 N 5TH AVE
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City | SEQUIM
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State | WA
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Zip | 98382-3079
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Country | US
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Telephone | 360-417-8630
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Fax | 360-417-8635
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Provider Business Mailing Address
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Address Line | 1112 CAROLINE ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-4204
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Country | US
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Telephone | 360-417-8630
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Fax | 360-417-8635
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Authorized Official
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Title or Position | PRESIDENT
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Name | REGINA MAY MCGOVERN
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Credential | M.D.
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Telephone | 360-417-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MD00038097
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT00003652
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10005046
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License Number State | WA
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