Provider Demographics
NPI:1407676752
Name:CHENOWITH, JACI ELIZABETH (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JACI
Middle Name:ELIZABETH
Last Name:CHENOWITH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 S KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2667
Mailing Address - Country:US
Mailing Address - Phone:501-249-0940
Mailing Address - Fax:
Practice Address - Street 1:1607 S KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2667
Practice Address - Country:US
Practice Address - Phone:479-223-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist