Provider Demographics
NPI:1245455211
Name:BENNETT, CHANTEL MILLER (OTR)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:MILLER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-8238
Mailing Address - Country:US
Mailing Address - Phone:575-393-0755
Mailing Address - Fax:
Practice Address - Street 1:315 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8238
Practice Address - Country:US
Practice Address - Phone:575-393-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284283-4201225X00000X
NMOT3727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist