Healthcare Provider Details

I. General information

NPI: 1336344191
Provider Name (Legal Business Name): CHANDRA LEN GARDNER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W STATE HIGHWAY 114
GRAPEVINE TX
76051-8649
US

IV. Provider business mailing address

2020 W STATE HIGHWAY 114
GRAPEVINE TX
76051-8649
US

V. Phone/Fax

Practice location:
  • Phone: 214-867-6600
  • Fax:
Mailing address:
  • Phone: 972-571-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: