MEDICARE: NICOLE CHAPMAN COTA/L

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	225X00000X	Occupational Therapist	13631	FL

General Provider Information

NPI Number	:	1992170815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CHAPMAN COTA/L

Provider Business Mailing Address
First Line	:	912 BOULDER DR
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1718
Country	:	US
Telephone Number	:	386-451-8414
Fax Number	:	386-673-9569

Provider Business Practice Location Address
First Line	:	16 BLACK WATER WAY
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5706
Country	:	US
Telephone Number	:	386-871-0428
Fax Number	:	386-673-9569

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

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/03/2015

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Directions to “ NICOLE CHAPMAN COTA/L” Practice Location

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