Provider Demographics
NPI:1649994757
Name:FROMMER, CHELSEY (RCP)
Entity type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:
Last Name:FROMMER
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:ORTWINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCP
Mailing Address - Street 1:101 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1915
Mailing Address - Country:US
Mailing Address - Phone:954-649-8391
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE FL 8
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-425-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44010063342279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4401006334OtherLARA