Provider Demographics
NPI:1134539539
Name:CHANDLER, MISTY
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 4TH AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1428
Mailing Address - Country:US
Mailing Address - Phone:304-523-1164
Mailing Address - Fax:304-522-2474
Practice Address - Street 1:845 4TH AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1428
Practice Address - Country:US
Practice Address - Phone:304-523-1164
Practice Address - Fax:304-522-2474
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist