Provider Demographics
NPI:1538690961
Name:OTELSBERG, CHANTAL ELISABETH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:ELISABETH
Last Name:OTELSBERG
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 KANFER CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-2675
Mailing Address - Country:US
Mailing Address - Phone:704-315-9533
Mailing Address - Fax:
Practice Address - Street 1:7100 KANFER CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2675
Practice Address - Country:US
Practice Address - Phone:704-315-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered