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General NPI Number Information
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NPI Number | 1184786410
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Entity Type | Individual
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Provider Name | BRIAN J CHASE MOT OTRL
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 100 DENNIS ST SW STE A
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City | TUMWATER
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State | WA
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Zip | 98501-6523
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Country | US
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Telephone | 360-819-4335
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Fax | 360-819-4339
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Provider Business Mailing Address
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Address Line | 100 DENNIS ST SW STE B
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City | TUMWATER
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State | WA
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Zip | 98501-6523
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Country | US
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Telephone | 360-338-0181
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Fax | 360-338-0257
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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 | OT00003562
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License Number State | WA
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