1457875486 NPI number — CHELSEA F LABOVE OTR/L, CLT

Table of content: CHELSEA F LABOVE OTR/L, CLT (NPI 1457875486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457875486 NPI number — CHELSEA F LABOVE OTR/L, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABOVE
Provider First Name:
CHELSEA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457875486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3566 SPOLETO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-738-4364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6841 S. EASTERN AVE
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-367-6015
Provider Business Practice Location Address Fax Number:
702-367-0614
Provider Enumeration Date:
08/01/2017

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: 225X00000X , with the licence number:  118488 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118488 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 384093 . This is a "OCCUPATIONAL THERAPIST" identifier . This identifiers is of the category "OTHER".




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