Provider Demographics
NPI:1083019434
Name:LABRADOR CHIN, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LABRADOR CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 PARK AVE
Mailing Address - Street 2:STE 610
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5720
Mailing Address - Country:US
Mailing Address - Phone:901-761-4263
Mailing Address - Fax:
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:STE 610
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-761-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4501225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand