MEDICARE: TERESA MAGDALINA CHANDLER

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1295511038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MAGDALINA CHANDLER

Provider Business Mailing Address
First Line	:	13560 US HIGHWAY 19 S
Second Line	:
City	:	ROANOKE
State	:	WV
Zip	:	26447-8237
Country	:	US
Telephone Number	:	509-287-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	13560 US HIGHWAY 19 S
Second Line	:
City	:	ROANOKE
State	:	WV
Zip	:	26447-8237
Country	:	US
Telephone Number	:	509-287-1184
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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Directions to “ TERESA MAGDALINA CHANDLER ” Practice Location

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