MEDICARE: ASHLEY R CHAPENDAMA

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	261QR0400X	Rehabilitation Clinic/Center
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1659120251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY R CHAPENDAMA

Provider Business Mailing Address
First Line	:	20 PLYMOUTH ST # B
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02907-2918
Country	:	US
Telephone Number	:	617-893-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PLYMOUTH ST # B
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02907-2918
Country	:	US
Telephone Number	:	617-893-2182
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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Directions to “ ASHLEY R CHAPENDAMA ” Practice Location

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