Provider Demographics
NPI:1396913786
Name:KAPELKE, STACIA JEAN
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:JEAN
Last Name:KAPELKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:JEAN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 W ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2203
Mailing Address - Country:US
Mailing Address - Phone:509-939-2276
Mailing Address - Fax:
Practice Address - Street 1:3111 W ALICE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2203
Practice Address - Country:US
Practice Address - Phone:509-939-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC616079801041C0700X
WAOT60013314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical