Provider Demographics
NPI:1215452396
Name:CHAMOUN, SANDRA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:CHAMOUN
Suffix:
Gender:F
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 1:32 MILTON HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2672
Mailing Address - Country:US
Mailing Address - Phone:917-613-0433
Mailing Address - Fax:
Practice Address - Street 1:2 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1702
Practice Address - Country:US
Practice Address - Phone:518-926-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020579-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314998Medicaid