Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1144538679 |
---|---|
Provider Name | Theresa M Chattman |
First Address | Prattville, AL 36066-5631 |
Second Address | Prattville, AL 36066-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2010 |
Last Update Date | 17/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009948105 | (05) | AL |