MEDICARE: CHLOE GRACE DOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	028377	NY

General Provider Information

NPI Number	:	1023879509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOE GRACE DOW

Provider Business Mailing Address
First Line	:	126 VANDERKEMP AVE
Second Line	:
City	:	BARNEVELD
State	:	NY
Zip	:	13304-2427
Country	:	US
Telephone Number	:	315-520-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 W TAFT RD STE 202
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-2806
Country	:	US
Telephone Number	:	315-552-0406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	11/25/2024

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