Provider Demographics
NPI:1508380395
Name:YEWCHIN, AUDRA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:
Last Name:YEWCHIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 B ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5926
Mailing Address - Country:US
Mailing Address - Phone:907-245-7325
Mailing Address - Fax:907-313-7893
Practice Address - Street 1:4300 B ST STE 104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5926
Practice Address - Country:US
Practice Address - Phone:907-929-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
AK124568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation