MEDICARE: MRS. CHENIN KAE CHESTNUT 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		IN

General Provider Information

NPI Number	:	1528019718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHENIN KAE CHESTNUT OTR/L

Provider Business Mailing Address
First Line	:	11630 SANDWOOD CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6038
Country	:	US
Telephone Number	:	317-716-8226
Fax Number	:	317-823-2414

Provider Business Practice Location Address
First Line	:	9505 E 59TH ST
Second Line	:	SUITE B1
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-1025
Country	:	US
Telephone Number	:	317-716-8226
Fax Number	:	317-823-2414

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	09/17/2007

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