Provider Demographics
NPI:1134313901
Name:STAUFFER, SALLY ALICE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ALICE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 N HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-3527
Mailing Address - Country:US
Mailing Address - Phone:971-222-5360
Mailing Address - Fax:
Practice Address - Street 1:2135 N HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-3527
Practice Address - Country:US
Practice Address - Phone:971-222-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR233980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist