Healthcare Provider Details

I. General information

NPI: 1518326172
Provider Name (Legal Business Name): MISS ELEANOR CHANDHOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CHASTAIN MEADOWS PKWY NW STE 200
KENNESAW GA
30144-5881
US

IV. Provider business mailing address

6505 SHILOH RD STE 100
ALPHARETTA GA
30005-1645
US

V. Phone/Fax

Practice location:
  • Phone: 678-648-7644
  • Fax:
Mailing address:
  • Phone: 678-648-7644
  • Fax: 678-882-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4651
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: