Provider Demographics
NPI:1851434997
Name:TEACHNOR-HAUK, DESTINY CHANTELLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:CHANTELLE
Last Name:TEACHNOR-HAUK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 AVERILL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-1402
Mailing Address - Country:US
Mailing Address - Phone:517-882-6365
Mailing Address - Fax:
Practice Address - Street 1:3200 AVERILL DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-1402
Practice Address - Country:US
Practice Address - Phone:517-882-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer