Provider Demographics
NPI:1417482209
Name:BAKER, CHANTELL CORDELL (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTELL
Middle Name:CORDELL
Last Name:BAKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:CHANTELL
Other - Middle Name:CORDELL
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4918 ASHBY ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1045
Mailing Address - Country:US
Mailing Address - Phone:907-947-7017
Mailing Address - Fax:
Practice Address - Street 1:600 22ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0055
Practice Address - Country:US
Practice Address - Phone:202-994-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000173592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer