MEDICARE: JILL CHAMBERLIN OTR

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	1050	CO

General Provider Information

NPI Number	:	1033409958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL CHAMBERLIN OTR

Provider Business Mailing Address
First Line	:	1973 INTERLOCKEN DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-8952
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2987 BERGEN PEAK DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2205
Country	:	US
Telephone Number	:	303-674-4500
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/20/2011

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