Provider Demographics
NPI:1710505441
Name:DECKER, CHELSEA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
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 1:1170 S SCHODACK RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-3056
Mailing Address - Country:US
Mailing Address - Phone:518-256-8986
Mailing Address - Fax:
Practice Address - Street 1:26 COMPUTER DR E
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1112
Practice Address - Country:US
Practice Address - Phone:518-438-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist