Provider Demographics
NPI:1710227046
Name:OWEN, CHANTAL (CMT, CR, CCA)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:CMT, CR, CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 WOLFSNARE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3422
Mailing Address - Country:US
Mailing Address - Phone:757-343-3902
Mailing Address - Fax:
Practice Address - Street 1:2240 WOLFSNARE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3422
Practice Address - Country:US
Practice Address - Phone:757-343-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist