Provider Demographics
NPI:1033716410
Name:CHAPHE, LISA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CHAPHE
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 1:215 W CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4111
Mailing Address - Country:US
Mailing Address - Phone:770-845-7124
Mailing Address - Fax:
Practice Address - Street 1:15 THOMAS GRACE ANNEX LN
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3653
Practice Address - Country:US
Practice Address - Phone:470-414-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty