Provider Demographics
NPI:1225192412
Name:STALHEIM, CHUE (OT)
Entity Type:Individual
Prefix:
First Name:CHUE
Middle Name:
Last Name:STALHEIM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 HIBERNIAN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3788
Mailing Address - Country:US
Mailing Address - Phone:843-781-1330
Mailing Address - Fax:
Practice Address - Street 1:555 W CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4449
Practice Address - Country:US
Practice Address - Phone:854-777-4465
Practice Address - Fax:414-449-4448
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4255-026225X00000X
SC3902225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41042900Medicaid