Provider Demographics
NPI:1275041402
Name:STAVES, CHASSIDY CROSS
Entity Type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:CROSS
Last Name:STAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:2045 WHISPERING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8476
Practice Address - Country:US
Practice Address - Phone:270-993-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist