Provider Demographics
NPI:1578798765
Name:CHONKO OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:CHONKO OCCUPATIONAL THERAPY, LLC
Other - Org Name:KID O'THERAPY,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHONKO
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:207-841-1560
Mailing Address - Street 1:41 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1285
Mailing Address - Country:US
Mailing Address - Phone:207-841-1560
Mailing Address - Fax:
Practice Address - Street 1:41 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1285
Practice Address - Country:US
Practice Address - Phone:207-844-8287
Practice Address - Fax:207-844-8245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHONKO OCCUPATIONAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-18
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 225XP0019X, 2355S0801X, 235Z00000X
MEOT1416225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME43337500Medicaid