Provider Demographics
NPI:1073155065
Name:STAVES OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:STAVES OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHASSIDY
Authorized Official - Middle Name:CROSS
Authorized Official - Last Name:STAVES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:270-993-6959
Mailing Address - Street 1:2045 WHISPERING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8476
Mailing Address - Country:US
Mailing Address - Phone:270-993-6959
Mailing Address - Fax:
Practice Address - Street 1:2200 E PARRISH AVE BLDG C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-681-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100628840Medicaid