Provider Demographics
NPI:1285220673
Name:KAPUSCIENSKI, CHASE
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:KAPUSCIENSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TULIP CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1250
Mailing Address - Country:US
Mailing Address - Phone:508-736-4539
Mailing Address - Fax:
Practice Address - Street 1:61 TULIP CIR
Practice Address - Street 2:
Practice Address - City:SOUTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01560-1250
Practice Address - Country:US
Practice Address - Phone:508-736-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer