Provider Demographics
NPI:1598267098
Name:CHINN, EL' MALIK (OTR/L)
Entity Type:Individual
Prefix:
First Name:EL' MALIK
Middle Name:
Last Name:CHINN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CAEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-3416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1479 GROVE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1585
Practice Address - Country:US
Practice Address - Phone:706-530-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4643225X00000X
GAOT007474225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist