Provider Demographics
NPI:1992387567
Name:CHAPMAN, KELSEA ALAINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KELSEA
Middle Name:ALAINE
Last Name:CHAPMAN
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 1:9887 COUNTY ROAD 3129D
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75669-8806
Mailing Address - Country:US
Mailing Address - Phone:903-646-0108
Mailing Address - Fax:
Practice Address - Street 1:100 E ELM ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2510
Practice Address - Country:US
Practice Address - Phone:903-646-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant