Provider Demographics
NPI:1851131650
Name:CHAMBLIN, COLBY R (OT)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:R
Last Name:CHAMBLIN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:COLBY
Other - Middle Name:RYAN
Other - Last Name:CHAMBLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:3903 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1426
Mailing Address - Country:US
Mailing Address - Phone:405-585-2971
Mailing Address - Fax:405-585-2983
Practice Address - Street 1:3903 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1426
Practice Address - Country:US
Practice Address - Phone:405-585-2971
Practice Address - Fax:405-585-2983
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist