Provider Demographics
NPI:1902488364
Name:CHAVIS, BARBARA DAWN (OTA COTA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:DAWN
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:OTA COTA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:DAWN
Other - Last Name:CHAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4706
Mailing Address - Country:US
Mailing Address - Phone:203-723-1456
Mailing Address - Fax:
Practice Address - Street 1:4 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4706
Practice Address - Country:US
Practice Address - Phone:203-723-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant