Provider Demographics
NPI:1104135458
Name:CHAVEZ, WALTER E JR (OTR/L)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:CHAVEZ
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07091-0039
Mailing Address - Country:US
Mailing Address - Phone:201-650-0903
Mailing Address - Fax:908-233-2267
Practice Address - Street 1:918 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1415
Practice Address - Country:US
Practice Address - Phone:201-650-0903
Practice Address - Fax:908-233-2267
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00278100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist