Provider Demographics
NPI:1821209123
Name:CHEPOLIS, DEBORAH ATHA (LOTR)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ATHA
Last Name:CHEPOLIS
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2845
Mailing Address - Country:US
Mailing Address - Phone:504-931-8488
Mailing Address - Fax:
Practice Address - Street 1:754 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2845
Practice Address - Country:US
Practice Address - Phone:504-931-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11812225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1198862Medicaid