Provider Demographics
NPI:1063796175
Name:PEAK PERFORMANCE THERAPY LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:STAEBEN
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:360-683-8331
Mailing Address - Street 1:519 EUREKA WAY, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-683-8331
Mailing Address - Fax:360-683-8441
Practice Address - Street 1:519 EUREKA WAY, SUITE 2
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-8331
Practice Address - Fax:360-683-8441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00003652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty