Healthcare Provider Details

I. General information

NPI: 1417870437
Provider Name (Legal Business Name): EMILY CHATHAM MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S MAIN ST
KNOX IN
46534-1918
US

IV. Provider business mailing address

6767 N STATE ROAD 17
CULVER IN
46511-9323
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-1654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008908A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: