Provider Demographics
NPI:1649761412
Name:STACHE, JOSEPHINE I
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:STACHE
Suffix:I
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:S66W22360 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9516
Mailing Address - Country:US
Mailing Address - Phone:414-339-5071
Mailing Address - Fax:
Practice Address - Street 1:3136 S 95TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4323
Practice Address - Country:US
Practice Address - Phone:414-339-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant