Provider Demographics
NPI:1952923278
Name:EBERLE, CHESANY (OTD)
Entity Type:Individual
Prefix:
First Name:CHESANY
Middle Name:
Last Name:EBERLE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-1312
Mailing Address - Country:US
Mailing Address - Phone:402-641-8295
Mailing Address - Fax:
Practice Address - Street 1:745 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-1312
Practice Address - Country:US
Practice Address - Phone:402-641-8295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2233OtherOCCUPATIONAL THERAPIST LICENSE