Provider Demographics
NPI:1518192269
Name:STAAB, EMILY DIANNE (MOTR)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DIANNE
Last Name:STAAB
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9182
Mailing Address - Country:US
Mailing Address - Phone:765-414-3579
Mailing Address - Fax:
Practice Address - Street 1:8921 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1084
Practice Address - Country:US
Practice Address - Phone:317-881-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004598A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist