Provider Demographics
NPI:1902323066
Name:CHATTERTON, AMY JO (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:CHATTERTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 3RD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1559
Mailing Address - Country:US
Mailing Address - Phone:304-634-5705
Mailing Address - Fax:
Practice Address - Street 1:1102 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1559
Practice Address - Country:US
Practice Address - Phone:304-634-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist