Provider Demographics
NPI:1053620138
Name:CHAPMAN, ANGELA THERESA (MSOTR/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:THERESA
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:THERESA
Other - Last Name:KUBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:15 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7997
Mailing Address - Country:US
Mailing Address - Phone:207-621-7500
Mailing Address - Fax:
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7997
Practice Address - Country:US
Practice Address - Phone:207-621-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist