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General NPI Number Information
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NPI Number | 1407126923
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Entity Type | Individual
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Provider Name | MS. PATRICIA MARIE CHISOLM
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Gender | Female
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Dates
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Enumeration Date | 01/02/2012
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Last Update Date | 01/02/2012
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Provider Practice Location Address
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Address Line | 2708 NE 14TH ST SUITE 5
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3565
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Country | US
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Telephone | 188-888-0927
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2472
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City | BLUFFTON
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State | SC
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Zip | 29910-2472
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Country | US
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Telephone | 843-295-8863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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