Provider Demographics
NPI:1558637751
Name:CHAPMAN, JOHN JASON (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JASON
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DUCK CV
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3576
Mailing Address - Country:US
Mailing Address - Phone:860-896-1153
Mailing Address - Fax:
Practice Address - Street 1:25 DUCK CV
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3576
Practice Address - Country:US
Practice Address - Phone:860-896-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001277224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant