Healthcare Provider Details

I. General information

NPI: 1801957337
Provider Name (Legal Business Name): CHANDANA DASH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CEDAR CT
CARBONDALE IL
62901-5300
US

IV. Provider business mailing address

606 COUNTRY CLUB LN
CARTERVILLE IL
62918-1629
US

V. Phone/Fax

Practice location:
  • Phone: 618-243-7822
  • Fax: 618-529-4560
Mailing address:
  • Phone: 618-542-8950
  • Fax: 618-542-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.006981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: