Healthcare Provider Details

I. General information

NPI: 1194127829
Provider Name (Legal Business Name): CHANTAE WARD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 I 55 S
BYRAM MS
39272-9402
US

IV. Provider business mailing address

9904 CROOKED CREEK CIR
BYRAM MS
39272-4426
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-9899
  • Fax:
Mailing address:
  • Phone: 804-938-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001286
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: