Provider Demographics
NPI:1811245582
Name:CHAMBERLAIN, VINCENT JAMES (OCCUPATIONAL THER)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:OCCUPATIONAL THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5210
Mailing Address - Country:US
Mailing Address - Phone:814-943-1272
Mailing Address - Fax:814-940-8516
Practice Address - Street 1:300 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5210
Practice Address - Country:US
Practice Address - Phone:814-943-1272
Practice Address - Fax:814-940-8516
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012443364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health