Provider Demographics
NPI:1235260787
Name:CASTANEDA, CHANTELLE INEZ (OTR)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:INEZ
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 EMERALD TIDE WAY
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6463
Mailing Address - Country:US
Mailing Address - Phone:915-204-5137
Mailing Address - Fax:915-771-8046
Practice Address - Street 1:6028 SURETY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2018
Practice Address - Country:US
Practice Address - Phone:915-771-8523
Practice Address - Fax:915-771-8046
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist