Provider Demographics
NPI:1740910827
Name:CHAPMAN, BRIDGET SHAIRELL
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:SHAIRELL
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 1:1651 W PALMETTO ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4133
Mailing Address - Country:US
Mailing Address - Phone:843-453-3401
Mailing Address - Fax:
Practice Address - Street 1:1651 W PALMETTO ST STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4133
Practice Address - Country:US
Practice Address - Phone:843-453-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC755111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC831158641Medicaid