Provider Demographics
NPI:1700171345
Name:HUMPHREY, CHELSEA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:ELIZABEETH
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 CARRIAGE LAMP WAY
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-612-5167
Mailing Address - Fax:
Practice Address - Street 1:250 NW 76TH DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4388225X00000X
TX114485225X00000X
FL14833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist