Provider Demographics
NPI:1609434992
Name:WOOD, CHAD B (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:B
Last Name:WOOD
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 1:119 LOUISVILLE LN
Mailing Address - Street 2:
Mailing Address - City:WALLINS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40873-8941
Mailing Address - Country:US
Mailing Address - Phone:606-273-0911
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-0014
Practice Address - Country:US
Practice Address - Phone:606-573-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist