MEDICARE: MRS. CARA SEIDELL CHANNING OTR L MOT

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	225XH1200X	Hand Occupational Therapist	OT00004071	WA
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1871654715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARA SEIDELL CHANNING OTR L MOT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-682-8840
Fax Number	:	423-602-2028

Provider Business Practice Location Address
First Line	:	4411 POINT FOSDICK DR NW STE 101
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1703
Country	:	US
Telephone Number	:	253-851-7472
Fax Number	:	253-851-7473

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/29/2019

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