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Individual

MRS. HEATHER LYNN CHANSUTHUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
1113 SHALLOWBROOK TRL S, ANTIOCH, TN 37013-2468
(615) 487-1711
Mailing address
1113 SHALLOWBROOK TRL S, ANTIOCH, TN 37013-2468
(615) 487-1711

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
408395
TN

Other

Enumeration date
05/17/2013
Last updated
05/17/2013
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