Provider Demographics
NPI:1003079641
Name:CHAPUT, AUDREY MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MARIE
Last Name:CHAPUT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WILDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-2808
Mailing Address - Country:US
Mailing Address - Phone:612-867-4513
Mailing Address - Fax:
Practice Address - Street 1:750 WILDRIDGE CT
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-2808
Practice Address - Country:US
Practice Address - Phone:612-867-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100147225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist