MEDICARE: CASSANDRA GRACE CHAPPELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SZ11492	FL

General Provider Information

NPI Number	:	1629835921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA GRACE CHAPPELL

Provider Business Mailing Address
First Line	:	2632 HOLLY POINT RD E
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 HOLLY POINT RD E
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5635
Country	:	US
Telephone Number	:	786-348-5569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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Directions to “ CASSANDRA GRACE CHAPPELL ” Practice Location

Language	Start Address	Practice Location

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