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General NPI Number Information
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NPI Number | 1801595137
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Entity Type | Individual
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Provider Name | CHAD JASON VERNON OT
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Gender | Male
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 3111 CLEARWATER DR STE C
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City | PRESCOTT
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State | AZ
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Zip | 86305-7186
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Country | US
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Telephone | 928-777-9890
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Fax | 928-777-9891
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Provider Business Mailing Address
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Address Line | 905 HARRIS LN
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City | BLANDING
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State | UT
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Zip | 84511-3345
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Country | US
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Telephone | 970-297-8986
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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 | 11151675-4201
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License Number State | UT
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