Provider Demographics
NPI:1720426323
Name:STAPLES, NATASHA RENEE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEE
Last Name:STAPLES
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 1:3468 MAN O WAR LOOP N
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2455
Mailing Address - Country:US
Mailing Address - Phone:859-699-0046
Mailing Address - Fax:
Practice Address - Street 1:3468 MAN O WAR LOOP N
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2455
Practice Address - Country:US
Practice Address - Phone:859-699-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency