Provider Demographics
NPI:1184786410
Name:CHASE, BRIAN J (MOT OTRL)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:CHASE
Suffix:
Gender:M
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:100 DENNIS ST SW STE A
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6523
Practice Address - Country:US
Practice Address - Phone:360-819-4335
Practice Address - Fax:360-819-4339
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346751Medicaid
WA4254CHOtherREGENCE GH
WA1687CHOtherREGENCE TAC
WA204660OtherLABOR & INDUSTRIES
WA4254CHOtherREGENCE GH