MEDICARE: JAMES A. STAEBEN OTR/L, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT00003652	WA
2	225XH1200X	Hand Occupational Therapist	OT00003652	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O00034530	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639123110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A. STAEBEN OTR/L, CHT

Provider Business Mailing Address
First Line	:	578 N. 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3079
Country	:	US
Telephone Number	:	360-683-8331
Fax Number	:	360-683-8441

Provider Business Practice Location Address
First Line	:	578 N. 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3079
Country	:	US
Telephone Number	:	360-683-8331
Fax Number	:	360-683-8331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/17/2012

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