Basic Information
| Provider Information | |||||||||
| NPI: | 1134896665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAUP | ||||||||
| FirstName: | CHANDA | ||||||||
| MiddleName: | BRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 596 JOJO RD. | ||||||||
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| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145980922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1028 E 2ND ST | ||||||||
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| City: | COUDERSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169158306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142747610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.