MEDICARE: MS. VICTORIA CHANDLER OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0116611	NY
2	225X00000X	Occupational Therapist	0119004579	VA

General Provider Information

NPI Number	:	1164636478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA CHANDLER OTRL

Provider Business Mailing Address
First Line	:	4707 WOODSTREAM DR
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-8801
Country	:	US
Telephone Number	:	804-733-7261
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 WOODSTREAM DR
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-8801
Country	:	US
Telephone Number	:	804-733-7261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/25/2013

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