Provider Demographics
NPI:1801957337
Name:DASH, CHANDANA (OTR)
Entity type:Individual
Prefix:MS
First Name:CHANDANA
Middle Name:
Last Name:DASH
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 1:606 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1629
Mailing Address - Country:US
Mailing Address - Phone:618-542-8950
Mailing Address - Fax:618-542-8746
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1422
Practice Address - Country:US
Practice Address - Phone:618-542-8950
Practice Address - Fax:618-542-8746
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212514Medicare ID - Type UnspecifiedPROVIDER GROUP ID#