Provider Demographics
NPI:1285751404
Name:STAATS, BOBBIE DALE
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:DALE
Last Name:STAATS
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 1:8507 W AVENUE E12
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7013
Mailing Address - Country:US
Mailing Address - Phone:661-728-9363
Mailing Address - Fax:
Practice Address - Street 1:43423 DIVISION ST STE 107
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4640
Practice Address - Country:US
Practice Address - Phone:661-726-2850
Practice Address - Fax:661-726-2854
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner