Provider Demographics
NPI:1144785528
Name:PAGE, CHANTA
Entity Type:Individual
Prefix:MISS
First Name:CHANTA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 PARAGON PL STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:844-892-9261
Practice Address - Street 1:6802 PARAGON PL STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1655
Practice Address - Country:US
Practice Address - Phone:919-358-3730
Practice Address - Fax:844-892-9261
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health