Healthcare Provider Details

I. General information

NPI: 1437884442
Provider Name (Legal Business Name): STEVEN ALBERT CHASE OT/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E DOWNING ST
TAHLEQUAH OK
74464-3324
US

IV. Provider business mailing address

1400 E DOWNING ST
TAHLEQUAH OK
74464-3324
US

V. Phone/Fax

Practice location:
  • Phone: 918-506-6870
  • Fax: 918-453-9409
Mailing address:
  • Phone: 918-506-6870
  • Fax: 918-453-9409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT1071
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1003865999
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: