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NPI Code Detail

MEDICARE: CHELSEA NICHOLE GARDNER OTA06297

MEDICARE: CHELSEA NICHOLE GARDNER OTA06297
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
1224Z00000XOccupational Therapy Assistant06297OH

General Provider Information

NPI Number : 1932921335
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEA NICHOLE GARDNER OTA06297
Provider Business Mailing Address
First Line : 4608 OLDE PARK DR
Second Line :
City : TIPP CITY
State : OH
Zip : 45371-9193
Country : US
Telephone Number : 937-974-1872
Fax Number :
Provider Business Practice Location Address
First Line : 4375 S COUNTY ROAD 25A
Second Line :
City : TIPP CITY
State : OH
Zip : 45371-2956
Country : US
Telephone Number : 937-667-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2024
Last Update Date : 10/28/2024

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