Provider Demographics
NPI:1699491126
Name:STURTEVANT, JACOB C (OTD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:STURTEVANT
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 N NORMANDIE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2521
Mailing Address - Country:US
Mailing Address - Phone:503-919-0064
Mailing Address - Fax:
Practice Address - Street 1:5322 N DIVISION ST # 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1300
Practice Address - Country:US
Practice Address - Phone:509-487-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61368150225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand