Provider Demographics
NPI:1437907417
Name:CHILDERS, CHAD O'KEEFE (COTA/L)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:O'KEEFE
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TOWNSHIP ROAD 1020
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7871
Mailing Address - Country:US
Mailing Address - Phone:304-634-7617
Mailing Address - Fax:
Practice Address - Street 1:5850 US 60
Practice Address - Street 2:SUITE B
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-928-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288729224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant