Provider Demographics
NPI:1295020485
Name:JORDAN CHAUSSE, LLC
Entity Type:Organization
Organization Name:JORDAN CHAUSSE, LLC
Other - Org Name:A COMMUNITY IN MOTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CHAUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:AAC
Authorized Official - Phone:603-443-9639
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-0334
Mailing Address - Country:US
Mailing Address - Phone:603-443-9639
Mailing Address - Fax:603-443-9659
Practice Address - Street 1:23 MAHAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1315
Practice Address - Country:US
Practice Address - Phone:603-443-9639
Practice Address - Fax:603-443-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH647013225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty