Provider Demographics
NPI:1205187531
Name:STAFFORD, ELAINE M (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 S TYLER ST
Mailing Address - Street 2:GRAY MIDDLE SCHOOL
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2522
Mailing Address - Country:US
Mailing Address - Phone:253-571-5200
Mailing Address - Fax:
Practice Address - Street 1:6229 S TYLER ST
Practice Address - Street 2:GRAY MIDDLE SCHOOL
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2522
Practice Address - Country:US
Practice Address - Phone:253-571-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist