Provider Demographics
NPI:1508258682
Name:METCALF, CHASSICA (COTA)
Entity Type:Individual
Prefix:
First Name:CHASSICA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 HIGHWAY 45A
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE
Mailing Address - State:MS
Mailing Address - Zip Code:39756-9787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10628 HIGHWAY 45A
Practice Address - Street 2:
Practice Address - City:PRAIRIE
Practice Address - State:MS
Practice Address - Zip Code:39756-9787
Practice Address - Country:US
Practice Address - Phone:662-436-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212819224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant