Basic Information
| Provider Information | |||||||||
| NPI: | 1811349202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAKI | ||||||||
| FirstName: | CHELSEA | ||||||||
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| OtherLastName: | POOL | ||||||||
| OtherFirstName: | CHELSEA | ||||||||
| OtherMiddleName: | RAE | ||||||||
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| OtherCredential: | MS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5762 BOLSA AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926491172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142922322 | ||||||||
| FaxNumber: | 7148664153 | ||||||||
| Practice Location | |||||||||
| Address1: | 5762 BOLSA AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926491172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142922322 | ||||||||
| FaxNumber: | 7148664153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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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 | 225XP0200X | 16420 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.