MEDICARE: MRS. CHANDELLE LEE RHODES OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	0736	NC

General Provider Information

NPI Number	:	1447234810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANDELLE LEE RHODES OT

Provider Business Mailing Address
First Line	:	20528 LAGOONA DR
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-7110
Country	:	US
Telephone Number	:	704-378-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD
Second Line	:	2ND FLOOR
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1019
Country	:	US
Telephone Number	:	704-366-5521
Fax Number	:	704-364-3953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/24/2011

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