Basic Information
| Provider Information | |||||||||
| NPI: | 1245683101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIGLER | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | CHUBB | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1549 HAVILAND PL | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945171051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089212810 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2701 N ROCKY POINT DR | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336075917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008920640 | ||||||||
| FaxNumber: | 8008920648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | 13477 | CA | Y | Other Service Providers | Contractor |
ID Information
| ID | Type | State | Issuer | Description | 308698 | 01 | NBCOT | OTHER |