Provider Demographics
NPI:1609996362
Name:STAHLY, JOYCE G (OT, CHT)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:G
Last Name:STAHLY
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:GRONSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR975026225X00000X
OR9410000312225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278178Medicaid
ORP01270257OtherRR MEDICARE
ORR147028Medicare PIN
ORP01270257OtherRR MEDICARE