Provider Demographics
NPI:1750612461
Name:POWELL, CHANTEL ROSE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:ROSE
Last Name:POWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 CARR DR.
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-685-7694
Mailing Address - Fax:760-945-9678
Practice Address - Street 1:3185 CARR DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-685-7694
Practice Address - Fax:760-945-9678
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist