Provider Demographics
NPI:1871877332
Name:STAPLES, JASON DREW (OTR/L)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DREW
Last Name:STAPLES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2251
Mailing Address - Country:US
Mailing Address - Phone:817-992-1495
Mailing Address - Fax:
Practice Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2251
Practice Address - Country:US
Practice Address - Phone:817-992-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003117225XE0001X
COOT-3117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification