Provider Demographics
NPI:1790410645
Name:BEWLEY, CHANDLER PAIGE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:PAIGE
Last Name:BEWLEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:PAIGE
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6200 WATKINS AVE APT F105
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3134
Mailing Address - Country:US
Mailing Address - Phone:951-491-5524
Mailing Address - Fax:
Practice Address - Street 1:2070 MCKENZIE RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0747
Practice Address - Country:US
Practice Address - Phone:479-750-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT22938225X00000X
AROTR3656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist