Provider Demographics
NPI:1295044501
Name:CHAMBERLAIN, GRETCHEN LYNETTE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LYNETTE
Last Name:CHAMBERLAIN
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 1:1401 J ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2221
Mailing Address - Country:US
Mailing Address - Phone:907-726-7151
Mailing Address - Fax:
Practice Address - Street 1:1401 J ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2221
Practice Address - Country:US
Practice Address - Phone:907-726-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1737225X00000X
COOT.0006848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist