Individual
CHRIS CHANTHABANDITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
17100 E SHEA BLVD STE 600, FOUNTAIN HILLS, AZ 85268-6663
(480) 837-4565
Mailing address
11825 N 25TH PL APT 301, PHOENIX, AZ 85028-6500
(616) 635-9722
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-008389
AZ
Other
Enumeration date
04/15/2021
Last updated
11/22/2024
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