Provider Demographics
NPI:1144650607
Name:CHALOT, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CHALOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MICHIGAN ST
Mailing Address - Street 2:PROGRESSIVE STEP CORPORATION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2903
Mailing Address - Country:US
Mailing Address - Phone:414-908-8781
Mailing Address - Fax:414-918-2573
Practice Address - Street 1:1883 SHUMWAY HILL ROAD
Practice Address - Street 2:BROAD ACRES HEALTH AND REHABILITATION CENTER
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901
Practice Address - Country:US
Practice Address - Phone:570-724-3913
Practice Address - Fax:414-918-2573
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007140224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant