Provider Demographics
NPI:1194443101
Name:WEINTRAUB, CHELSEY MARIE JOY
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:MARIE JOY
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:MARIE JOY
Other - Last Name:STRAIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 FALCON CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3252
Mailing Address - Country:US
Mailing Address - Phone:605-491-2832
Mailing Address - Fax:605-988-6648
Practice Address - Street 1:12450 CLOUD DR NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6274
Practice Address - Country:US
Practice Address - Phone:763-777-7117
Practice Address - Fax:651-401-0598
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist