1417593393 NPI number — MRS. CHELSEA BROOKE O'CONNER LSW

Table of content: (NPI 1922658434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417593393 NPI number — MRS. CHELSEA BROOKE O'CONNER LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNER
Provider First Name:
CHELSEA
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417593393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E. MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45822-1736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-584-5123
Provider Business Mailing Address Fax Number:
567-890-7214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 C. ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-584-5123
Provider Business Practice Location Address Fax Number:
567-890-7214
Provider Enumeration Date:
11/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: S.2005105 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0416120 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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