Healthcare Provider Details

I. General information

NPI: 1508380395
Provider Name (Legal Business Name): AUDRA YEWCHIN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 B ST STE 104
ANCHORAGE AK
99503-5926
US

IV. Provider business mailing address

4300 B ST STE 104
ANCHORAGE AK
99503-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-2253
  • Fax:
Mailing address:
  • Phone: 907-245-7325
  • Fax: 907-313-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number124568
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: