Provider Demographics
NPI:1790837334
Name:CHANNER, JOAN ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:CHANNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 SE WINDSONG LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8227
Mailing Address - Country:US
Mailing Address - Phone:617-875-0931
Mailing Address - Fax:
Practice Address - Street 1:6212 SE WINDSONG LN
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8227
Practice Address - Country:US
Practice Address - Phone:617-875-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics