Individual
CHANTEL LEE MCGRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(304) 298-3602
Mailing address
RR 1 BOX 499E, RIDGELEY, WV 26753-9762
(304) 298-3602
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
C1791
WV
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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