Provider Demographics
NPI:1396995825
Name:FITZPATRICK, CHIFFON NOREEN
Entity type:Individual
Prefix:
First Name:CHIFFON
Middle Name:NOREEN
Last Name:FITZPATRICK
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 1:2717 WHITMORE LN
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-2340
Mailing Address - Country:US
Mailing Address - Phone:570-643-8631
Mailing Address - Fax:
Practice Address - Street 1:2717 WHITMORE LN
Practice Address - Street 2:
Practice Address - City:BLAKESLEE
Practice Address - State:PA
Practice Address - Zip Code:18610-2340
Practice Address - Country:US
Practice Address - Phone:570-643-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09066100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant