Provider Demographics
NPI:1730245242
Name:CHAVES, LINDA (OTR)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CHAVES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 METROWEST BLVD
Mailing Address - Street 2:APT 306
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2461
Mailing Address - Country:US
Mailing Address - Phone:347-263-0950
Mailing Address - Fax:
Practice Address - Street 1:5560 METROWEST BLVD
Practice Address - Street 2:306
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2461
Practice Address - Country:US
Practice Address - Phone:347-263-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12576171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT12576OtherOTR LICENSE