Healthcare Provider Details

I. General information

NPI: 1932988896
Provider Name (Legal Business Name): CHELSEA NICOLE HURLBUT OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 ORTIZ
CORPUS CHRISTI TX
78414-4170
US

IV. Provider business mailing address

6105 ORTIZ
CORPUS CHRISTI TX
78414-4170
US

V. Phone/Fax

Practice location:
  • Phone: 603-833-9001
  • Fax:
Mailing address:
  • Phone: 603-833-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number218093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: