Provider Demographics
NPI:1053633065
Name:CHAPERON, SEPHORA (OTR/L)
Entity type:Individual
Prefix:
First Name:SEPHORA
Middle Name:
Last Name:CHAPERON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 126TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1511
Mailing Address - Country:US
Mailing Address - Phone:917-446-8641
Mailing Address - Fax:
Practice Address - Street 1:11116 126TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1511
Practice Address - Country:US
Practice Address - Phone:917-446-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296504-1164W00000X
NY017820-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse