Provider Demographics
NPI:1376815191
Name:ZANGRI, CHALICE CLARK (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CHALICE
Middle Name:CLARK
Last Name:ZANGRI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:DUCK HILL
Mailing Address - State:MS
Mailing Address - Zip Code:38925-9676
Mailing Address - Country:US
Mailing Address - Phone:662-565-2697
Mailing Address - Fax:
Practice Address - Street 1:101 WILSON ST
Practice Address - Street 2:
Practice Address - City:DUCK HILL
Practice Address - State:MS
Practice Address - Zip Code:38925-9676
Practice Address - Country:US
Practice Address - Phone:662-565-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTAO 536224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant