Provider Demographics
NPI:1255825998
Name:CHAPMAN, KENDRA RAE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:RAE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-6419
Mailing Address - Country:US
Mailing Address - Phone:618-741-5103
Mailing Address - Fax:
Practice Address - Street 1:214 LANEFIELD RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-8719
Practice Address - Country:US
Practice Address - Phone:910-293-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10553224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant