Provider Demographics
NPI:1700918182
Name:CHAMBERS, BRETT K
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:K
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:BRETT
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 93206
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3206
Mailing Address - Country:US
Mailing Address - Phone:505-822-8185
Mailing Address - Fax:505-822-8185
Practice Address - Street 1:7406 GETTYSBURG RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5026
Practice Address - Country:US
Practice Address - Phone:505-822-8185
Practice Address - Fax:505-822-8185
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM751224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant