MEDICARE: DEBRA L STAYLOR OTR 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	512673	OR
2	225XH1200X	Hand Occupational Therapist	512673	OR

General Provider Information

NPI Number	:	1740280361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA L STAYLOR OTR CHT

Provider Business Mailing Address
First Line	:	19365 SW 65TH AVE STE 200
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9196
Country	:	US
Telephone Number	:	503-692-5210
Fax Number	:	503-692-8821

Provider Business Practice Location Address
First Line	:	19365 SW 65TH AVE STE 200
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9196
Country	:	US
Telephone Number	:	503-692-5210
Fax Number	:	503-692-8821

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/20/2007

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