Provider Demographics
NPI:1578936563
Name:CHAM, WESLEY E (OT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:E
Last Name:CHAM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N HARBOR BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4127
Mailing Address - Country:US
Mailing Address - Phone:714-449-3305
Mailing Address - Fax:714-449-8462
Practice Address - Street 1:1440 N HARBOR BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4127
Practice Address - Country:US
Practice Address - Phone:714-449-3305
Practice Address - Fax:714-449-8462
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7607225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist