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General NPI Number Information
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NPI Number | 1619550449
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Entity Type | Individual
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Provider Name | CHANEL BECKER
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 2700 W 9TH AVE
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City | OSHKOSH
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State | WI
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Zip | 54904-7247
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Country | US
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Telephone | 920-223-2000
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Fax |
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Provider Business Mailing Address
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Address Line | N7360 COUNTY ROAD C
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City | ELDORADO
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State | WI
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Zip | 54932-9601
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Country | US
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Telephone | 920-979-2151
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5766-27
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License Number State | WI
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