Provider Demographics
NPI:1427408285
Name:VANDERSALL, CHELSEA (COTA)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:
Last Name:VANDERSALL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:43466-9821
Mailing Address - Country:US
Mailing Address - Phone:419-308-9960
Mailing Address - Fax:
Practice Address - Street 1:218 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:OH
Practice Address - Zip Code:43466-9821
Practice Address - Country:US
Practice Address - Phone:419-308-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06452224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant