Provider Demographics
NPI:1497176440
Name:CHAPMAN, BRENNA
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:CHAPMAN
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:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:MI
Mailing Address - Zip Code:48633-0111
Mailing Address - Country:US
Mailing Address - Phone:989-418-0532
Mailing Address - Fax:989-588-9047
Practice Address - Street 1:1900 S LACHANCE RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8022
Practice Address - Country:US
Practice Address - Phone:231-775-3081
Practice Address - Fax:231-775-7740
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist