Provider Demographics
NPI:1528516739
Name:ANTYPAS, CHANTALLE RALDA (OTR/L, GTS)
Entity type:Individual
Prefix:
First Name:CHANTALLE
Middle Name:RALDA
Last Name:ANTYPAS
Suffix:
Gender:F
Credentials:OTR/L, GTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4714
Mailing Address - Country:US
Mailing Address - Phone:509-946-1654
Mailing Address - Fax:509-943-5652
Practice Address - Street 1:1150 RIPLEY ST
Practice Address - Street 2:APT 205
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3475
Practice Address - Country:US
Practice Address - Phone:818-398-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60818103225XH1200X, 225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty