Provider Demographics
NPI:1164050209
Name:CHAMBERS, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CHAMBERS
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 1:1401 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:CO
Mailing Address - Zip Code:80650-1147
Mailing Address - Country:US
Mailing Address - Phone:509-378-4912
Mailing Address - Fax:
Practice Address - Street 1:1500 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4262
Practice Address - Country:US
Practice Address - Phone:970-495-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004372225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics