Healthcare Provider Details

I. General information

NPI: 1528516739
Provider Name (Legal Business Name): CHANTALLE RALDA ANTYPAS OTR/L, GTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RIPLEY ST APT 205
SILVER SPRING MD
20910-3475
US

IV. Provider business mailing address

1351 FOWLER ST
RICHLAND WA
99352-4714
US

V. Phone/Fax

Practice location:
  • Phone: 818-398-6720
  • Fax:
Mailing address:
  • Phone: 509-946-1654
  • Fax: 509-943-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60818103
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT60818103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: