Provider Demographics
NPI:1831684885
Name:RAY, CHELSEA (CPO)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 COUNTY ROAD 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-259-9749
Mailing Address - Fax:352-259-8209
Practice Address - Street 1:761 COUNTY ROAD 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-9749
Practice Address - Fax:352-259-8209
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR322222Z00000X, 224P00000X
CFM02896224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO03691OtherAMERICAN BOARD CERTIFICATION FOR PROSTHETICS & ORTHOTICS
FLPOR322OtherFLORIDA DEPARTMENT OF HEALTH