Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 7041 | TN |
N | 225XP0200X | Occupational Therapist - Pediatrics | 7041 | TN |
NPI | 1063171890 |
---|---|
Provider Name | Anna Chancey |
First Address | Dalton, GA 30722-2378 |
Second Address | Cleveland, TN 37312-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 10/12/2021 |