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General NPI Number Information
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NPI Number | 1073134508
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Entity Type | Individual
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Provider Name | MR. JEREMIAH HOSEA DENARD CHAMBLISS
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Gender | Male
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 112 POST OAK RD
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City | YORKTOWN
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State | VA
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Zip | 23693-4967
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Country | US
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Telephone | 727-637-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 7TH AVE SE
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City | LARGO
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State | FL
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Zip | 33771-2726
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Country | US
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Telephone | 727-637-2178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT16304
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119009433
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License Number State | VA
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