Provider Demographics
NPI:1871654715
Name:CHANNING, CARA SEIDELL (OTR L MOT)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:SEIDELL
Last Name:CHANNING
Suffix:
Gender:F
Credentials:OTR L MOT
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:LYNN
Other - Last Name:SEIDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L MOT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-682-8840
Mailing Address - Fax:423-602-2028
Practice Address - Street 1:4411 POINT FOSDICK DR NW STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1703
Practice Address - Country:US
Practice Address - Phone:253-851-7472
Practice Address - Fax:253-851-7473
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004071225XH1200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8851458Medicare ID - Type Unspecified