Provider Demographics
NPI:1114678307
Name:CHABOT, EMMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CHABOT
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 1:3 CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9382
Mailing Address - Country:US
Mailing Address - Phone:207-590-4292
Mailing Address - Fax:
Practice Address - Street 1:407 POOL ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9714
Practice Address - Country:US
Practice Address - Phone:207-282-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4151OtherOT LICENSE