Healthcare Provider Details

I. General information

NPI: 1528433299
Provider Name (Legal Business Name): RAND CHUBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 9TH ST
DE PERE WI
54115-1393
US

IV. Provider business mailing address

4890 N OVERLAND RD APT 30
HOBART WI
54155-9287
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-5680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5724-26
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026-0123
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number572426
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: