Provider Demographics
NPI:1326567314
Name:CHAPPELL, TREVOR MICHAEL
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:MICHAEL
Last Name:CHAPPELL
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 1:19 HIGHLAND AVE STE 3199
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1585
Mailing Address - Country:US
Mailing Address - Phone:978-828-6727
Mailing Address - Fax:
Practice Address - Street 1:1 FIELDHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:HOLDERNESS
Practice Address - State:NH
Practice Address - Zip Code:03245
Practice Address - Country:US
Practice Address - Phone:603-535-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program