Provider Demographics
NPI:1093942658
Name:DOVERSPIKE, CHASE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:DOVERSPIKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 CRYSTAL SHORE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-5446
Mailing Address - Country:US
Mailing Address - Phone:817-312-1100
Mailing Address - Fax:866-442-3880
Practice Address - Street 1:13406 CAMERON RD
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-9789
Practice Address - Country:US
Practice Address - Phone:817-312-1100
Practice Address - Fax:866-442-3880
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110884225X00000X
CA6944225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist