Provider Demographics
NPI:1245778851
Name:ANGLIN, CHANDLER BENSON LONG (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:BENSON LONG
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 LAKEWOODS DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-7756
Mailing Address - Country:US
Mailing Address - Phone:970-389-7077
Mailing Address - Fax:
Practice Address - Street 1:701 N WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4548
Practice Address - Country:US
Practice Address - Phone:970-389-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3689225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist