Healthcare Provider Details

I. General information

NPI: 1740910827
Provider Name (Legal Business Name): BRIDGET SHAIRELL CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 W PALMETTO ST STE 3
FLORENCE SC
29501-4133
US

IV. Provider business mailing address

1651 W PALMETTO ST STE 3
FLORENCE SC
29501-4133
US

V. Phone/Fax

Practice location:
  • Phone: 843-453-3401
  • Fax:
Mailing address:
  • Phone: 843-453-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number75511
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: