Basic Information
| Provider Information | |||||||||
| NPI: | 1497176440 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHAPMAN | ||||||||
| FirstName: | BRENNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 111 | ||||||||
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| City: | LAKE GEORGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486330111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894180532 | ||||||||
| FaxNumber: | 9895889047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S LACHANCE RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496518022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317753081 | ||||||||
| FaxNumber: | 2317757740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2013 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.