Provider Demographics
NPI:1487102117
Name:LITTLE, CHAVIS ARRON (COTA QMA CNA HHA)
Entity type:Individual
Prefix:
First Name:CHAVIS
Middle Name:ARRON
Last Name:LITTLE
Suffix:
Gender:M
Credentials:COTA QMA CNA HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 FIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3029
Mailing Address - Country:US
Mailing Address - Phone:317-527-5437
Mailing Address - Fax:
Practice Address - Street 1:2519 E 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-4464
Practice Address - Country:US
Practice Address - Phone:317-527-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002792A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCNA0803732OtherCERTIFIED NURSE AIDE
INQMA1100021OtherQUALIFIED MEDICATION AIDE
INHHA1102475OtherHOME HEALTH AIDE
IN32002792AOtherOCC THERAPY ASSISTANT