Provider Demographics
NPI:1053005736
Name:CHAPPELL, MICHELLE PETRA (OTR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PETRA
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:PETRA
Other - Last Name:WUEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 POMEROY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6420
Mailing Address - Country:US
Mailing Address - Phone:413-212-1711
Mailing Address - Fax:
Practice Address - Street 1:140 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8533
Practice Address - Country:US
Practice Address - Phone:412-499-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist