Provider Demographics
NPI:1639123110
Name:STAEBEN, JAMES A (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:STAEBEN
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 N. 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3079
Mailing Address - Country:US
Mailing Address - Phone:360-683-8331
Mailing Address - Fax:360-683-8441
Practice Address - Street 1:578 N. 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-683-8331
Practice Address - Fax:360-683-8331
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003652225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
O00034530OtherRAILROAD MEDICARE
WA8329740Medicaid
O00034530OtherRAILROAD MEDICARE
WAAB37026Medicare ID - Type Unspecified
WA8329740Medicaid