Provider Demographics
NPI:1366100208
Name:CHAPMAN, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:PA
Mailing Address - Zip Code:16343-0065
Mailing Address - Country:US
Mailing Address - Phone:814-221-7724
Mailing Address - Fax:
Practice Address - Street 1:10 VO TECH DR
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-3502
Practice Address - Country:US
Practice Address - Phone:877-556-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist