Provider Demographics
NPI:1740441153
Name:ANANTACHOTE, CHONLADA
Entity type:Individual
Prefix:MRS
First Name:CHONLADA
Middle Name:
Last Name:ANANTACHOTE
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 1:505 INDIAN HILLS DR
Mailing Address - Street 2:APT C5
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9355
Mailing Address - Country:US
Mailing Address - Phone:208-301-8969
Mailing Address - Fax:
Practice Address - Street 1:200 S ALMON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2098
Practice Address - Country:US
Practice Address - Phone:208-882-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist