Provider Demographics
NPI:1841582715
Name:CHAPA, JACARANDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACARANDA
Middle Name:
Last Name:CHAPA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JACARANDA
Other - Middle Name:
Other - Last Name:CHAPA JOSEPHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 W 34TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2320
Mailing Address - Country:US
Mailing Address - Phone:646-812-1695
Mailing Address - Fax:
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:646-812-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist