Provider Demographics
NPI:1215163308
Name:CHAPMAN, KIMBERLY SUZANNE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAZY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2135
Mailing Address - Country:US
Mailing Address - Phone:317-852-5928
Mailing Address - Fax:317-286-3075
Practice Address - Street 1:210 LAZY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2135
Practice Address - Country:US
Practice Address - Phone:317-852-5928
Practice Address - Fax:317-286-3075
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN984096222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist