Provider Demographics
NPI:1962535336
Name:CHANCEY, ADRIA BRIANN (COTA)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:BRIANN
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 NATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6539
Mailing Address - Country:US
Mailing Address - Phone:678-450-3050
Mailing Address - Fax:
Practice Address - Street 1:4000 VILLAGE VIEW DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-4331
Practice Address - Country:US
Practice Address - Phone:678-450-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000889224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant