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NPI Code Detail

MEDICARE: CHASE ELWOOD OT

MEDICARE: CHASE ELWOOD OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT60934785WA

General Provider Information

NPI Number : 1174081004
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE ELWOOD OT
Provider Business Mailing Address
First Line : PO BOX 540640
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-0640
Country : US
Telephone Number : 801-987-8600
Fax Number : 801-987-8601
Provider Business Practice Location Address
First Line : 513 1ST AVE
Second Line :
City : ZILLAH
State : WA
Zip : 98953-9432
Country : US
Telephone Number : 509-829-5230
Fax Number : 509-829-5269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2019
Last Update Date : 03/11/2019

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Directions to “ CHASE ELWOOD OT” Practice Location

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