MEDICARE: CHELSEA LORRAINE STUTZMAN

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
1	224Z00000X	Occupational Therapy Assistant	OP009417	PA

General Provider Information

NPI Number	:	1588139893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA LORRAINE STUTZMAN

Provider Business Mailing Address
First Line	:	134 HILL RD
Second Line	:
City	:	HEGINS
State	:	PA
Zip	:	17938-9500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 WOODBINE LN
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17821-8020
Country	:	US
Telephone Number	:	570-275-5240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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