Provider Demographics
NPI:1811007958
Name:CHAFFEE, ROBERT (RPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 NW 63RD ST
Mailing Address - Street 2:STE 208
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1935
Mailing Address - Country:US
Mailing Address - Phone:405-608-4308
Mailing Address - Fax:
Practice Address - Street 1:3705 NW 63RD ST STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1937
Practice Address - Country:US
Practice Address - Phone:405-608-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200056430AMedicaid
OK200056430BMedicaid
TX174330401Medicaid
OK200056430BMedicaid
OK200056430AMedicaid