Basic Information
Provider Information
NPI: 1538762810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHALFIN
FirstName: REBECCA
MiddleName: ODELL
NamePrefix:  
NameSuffix:  
Credential: S/OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 530 S MAIN ST
Address2:  
City: LIMA
State: OH
PostalCode: 458041500
CountryCode: US
TelephoneNumber: 4192221168
FaxNumber:  
Practice Location
Address1: 2515 N MAIN ST
Address2:  
City: FINDLAY
State: OH
PostalCode: 458403972
CountryCode: US
TelephoneNumber: 4194228616
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/18/2020
LastUpdateDate: 11/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000XOTA004954OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


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