Provider Demographics
NPI:1508627357
Name:CHAMBERLAIN, ELAINE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0245
Mailing Address - Country:US
Mailing Address - Phone:913-313-8026
Mailing Address - Fax:
Practice Address - Street 1:5526 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6936
Practice Address - Country:US
Practice Address - Phone:913-313-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13699109-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist