MEDICARE: CHELSEY VELDBOOM 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	5831-26	WI

General Provider Information

NPI Number	:	1982063640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY VELDBOOM OTR

Provider Business Mailing Address
First Line	:	323 S 18TH AVE
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-1401
Country	:	US
Telephone Number	:	920-743-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 EGG HARBOR RD
Second Line	:	SUITE 108
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-1277
Country	:	US
Telephone Number	:	920-746-0410
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	10/26/2016

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