Provider Demographics
NPI:1386093128
Name:FUCCI, CHANTEL MICHELLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:MICHELLE
Last Name:FUCCI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 HALSBURY CIR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1721
Mailing Address - Country:US
Mailing Address - Phone:614-315-6169
Mailing Address - Fax:
Practice Address - Street 1:371 HALSBURY CIR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1721
Practice Address - Country:US
Practice Address - Phone:614-315-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0046122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer