Provider Demographics
NPI:1215126602
Name:CHAPMAN, STELLA (COTA/L)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4731
Mailing Address - Country:US
Mailing Address - Phone:505-623-2615
Mailing Address - Fax:505-622-6703
Practice Address - Street 1:412 N RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4731
Practice Address - Country:US
Practice Address - Phone:505-623-2615
Practice Address - Fax:505-622-6703
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1216224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant