Provider Demographics
NPI:1568598704
Name:CHAMBERLIN, THOMAS OTHENEAL (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:OTHENEAL
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:BASS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93604-0310
Mailing Address - Country:US
Mailing Address - Phone:559-974-1503
Mailing Address - Fax:
Practice Address - Street 1:300 E 15TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-6217
Practice Address - Country:US
Practice Address - Phone:209-381-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587265163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health