Provider Demographics
NPI:1386718757
Name:STARCEVICH, JAMIE L (OT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:STARCEVICH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:124
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701959225X00000X
KS1701291225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS120134Medicare PIN