Provider Demographics
NPI:1477117810
Name:FEGAN, CHOTSANI
Entity Type:Individual
Prefix:
First Name:CHOTSANI
Middle Name:
Last Name:FEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COMPTON RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3846
Mailing Address - Country:US
Mailing Address - Phone:513-328-7596
Mailing Address - Fax:
Practice Address - Street 1:800 COMPTON RD UNIT 7
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3846
Practice Address - Country:US
Practice Address - Phone:513-328-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist