Provider Demographics
NPI:1003001181
Name:CHAPPELL, THEO DICKINSON (HHP, LMBT)
Entity Type:Individual
Prefix:
First Name:THEO
Middle Name:DICKINSON
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:HHP, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRVIEW HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-9777
Mailing Address - Country:US
Mailing Address - Phone:828-713-1546
Mailing Address - Fax:
Practice Address - Street 1:2 FAIRVIEW HILLS DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NC
Practice Address - Zip Code:28730-9777
Practice Address - Country:US
Practice Address - Phone:828-713-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist