MEDICARE: CHASITY RHODEN OTR/L

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	OT16481	FL

General Provider Information

NPI Number	:	1487022463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASITY RHODEN OTR/L

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:
City	:	AMELIA ISLAND
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-491-1701
Fax Number	:

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

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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