Provider Demographics
NPI:1639614027
Name:CHANDLER, OCTAVIA CRYSTAL
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:CRYSTAL
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OCTAVIA
Other - Middle Name:
Other - Last Name:SILVESTRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRM, BA
Mailing Address - Street 1:557 NW MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4721
Mailing Address - Country:US
Mailing Address - Phone:541-766-6835
Mailing Address - Fax:
Practice Address - Street 1:557 NW MONROE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4721
Practice Address - Country:US
Practice Address - Phone:541-766-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist