Healthcare Provider Details

I. General information

NPI: 1912848433
Provider Name (Legal Business Name): CHANCE WETMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 TORKOM DR
NEW BRITAIN CT
06053-3486
US

IV. Provider business mailing address

87 TORKOM DR
NEW BRITAIN CT
06053-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-970-5993
  • Fax:
Mailing address:
  • Phone: 303-970-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-522108
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: