Provider Demographics
NPI:1881309011
Name:CHENOWETH, EMILY (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:CHENOWETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2819 33RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7818
Mailing Address - Country:US
Mailing Address - Phone:573-803-9258
Mailing Address - Fax:
Practice Address - Street 1:16500 92ND AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5444
Practice Address - Country:US
Practice Address - Phone:763-343-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106728225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist