Provider Demographics
NPI:1568846202
Name:TAVILL, CHELSEA BESS (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BESS
Last Name:TAVILL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 MAGUIRE WAY
Mailing Address - Street 2:UNIT 102
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-8500
Mailing Address - Country:US
Mailing Address - Phone:916-549-6090
Mailing Address - Fax:
Practice Address - Street 1:2208 CAMINO RAMON
Practice Address - Street 2:SUITE B
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1328
Practice Address - Country:US
Practice Address - Phone:925-830-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist